Healthcare Provider Details

I. General information

NPI: 1326512997
Provider Name (Legal Business Name): CASA COMPASIVA, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/17/2019
Last Update Date: 08/22/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9505 MINES RD STE 208
LAREDO TX
78045-8842
US

IV. Provider business mailing address

9505 MINES RD STE 209
LAREDO TX
78045-8842
US

V. Phone/Fax

Practice location:
  • Phone: 956-441-1362
  • Fax: 956-441-1304
Mailing address:
  • Phone: 956-729-7784
  • Fax: 956-729-1880

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code3747P1801X
TaxonomyPersonal Care Attendant
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code253Z00000X
TaxonomyIn Home Supportive Care Agency
License Number
License Number StateNULL

VIII. Authorized Official

Name: MR. RICHARD CHARLES KAHN
Title or Position: PRESIDENT
Credential:
Phone: 956-729-7784