Healthcare Provider Details

I. General information

NPI: 1649090960
Provider Name (Legal Business Name): ECC HOME
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/11/2024
Last Update Date: 10/11/2024
Certification Date: 10/11/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4218 PARKWOOD DR
SAN ANTONIO TX
78218-5024
US

IV. Provider business mailing address

4218 PARKWOOD DR
SAN ANTONIO TX
78218-5024
US

V. Phone/Fax

Practice location:
  • Phone: 210-982-2230
  • Fax:
Mailing address:
  • Phone: 210-982-2230
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: EBONY MILLSAP
Title or Position: CHIEF OPERATING OFFICER
Credential:
Phone: 210-982-2230