Healthcare Provider Details

I. General information

NPI: 1699052951
Provider Name (Legal Business Name): HEARTSHARE ADULT CARE LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/14/2011
Last Update Date: 11/14/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11603 W COKER LOOP STE. 101
SAN ANTONIO TX
78216-2820
US

IV. Provider business mailing address

11603 W COKER LOOP STE. 101
SAN ANTONIO TX
78216-2820
US

V. Phone/Fax

Practice location:
  • Phone: 210-521-9800
  • Fax:
Mailing address:
  • Phone: 210-521-9800
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code253Z00000X
TaxonomyIn Home Supportive Care Agency
License Number
License Number State

VIII. Authorized Official

Name: MRS. SHAWN MCCORMICK
Title or Position: OWNER
Credential:
Phone: 210-521-9800