Healthcare Provider Details

I. General information

NPI: 1598156630
Provider Name (Legal Business Name): MY MEDICAL NETWORK HOSPICE, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/11/2015
Last Update Date: 02/19/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

505 PLEASANTON RD
SAN ANTONIO TX
78214-1335
US

IV. Provider business mailing address

507 PLEASANTON RD
SAN ANTONIO TX
78214-1335
US

V. Phone/Fax

Practice location:
  • Phone: 210-422-2336
  • Fax:
Mailing address:
  • Phone: 210-422-2336
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251G00000X
TaxonomyCommunity Based Hospice Care Agency
License NumberJ8805
License Number StateTX

VIII. Authorized Official

Name: LUCINA TREVINO
Title or Position: MEMBER
Credential:
Phone: 210-422-2336