Healthcare Provider Details

I. General information

NPI: 1861656399
Provider Name (Legal Business Name): CMS PRIMARY HOME CARE, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/14/2008
Last Update Date: 02/10/2021
Certification Date: 02/10/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1003 BECKETT STE 106
SAN ANTONIO TX
78213-1353
US

IV. Provider business mailing address

1003 BECKETT STE 106
SAN ANTONIO TX
78213-1353
US

V. Phone/Fax

Practice location:
  • Phone: 956-424-9897
  • Fax: 866-800-3018
Mailing address:
  • Phone: 956-424-9897
  • Fax: 866-800-3018

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code251C00000X
TaxonomyDevelopmentally Disabled Services Day Training Agency
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code253Z00000X
TaxonomyIn Home Supportive Care Agency
License Number
License Number State
# 4
Primary TaxonomyY
Taxonomy Code3747P1801X
TaxonomyPersonal Care Attendant
License Number
License Number State

VIII. Authorized Official

Name: SANTIAGO P. MORIN
Title or Position: OWNER/ADMINISTRATOR
Credential:
Phone: 956-424-9897