Healthcare Provider Details

I. General information

NPI: 1649662495
Provider Name (Legal Business Name): PEDIATRIC ADVANCED LIFE SERVICES HOME HEALTH LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/02/2015
Last Update Date: 12/05/2025
Certification Date: 12/05/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

510 N VALLEY MILLS DR STE 201
WACO TX
76710-6076
US

IV. Provider business mailing address

510 N VALLEY MILLS DR STE 201
WACO TX
76710-6076
US

V. Phone/Fax

Practice location:
  • Phone: 254-307-8607
  • Fax: 254-765-2501
Mailing address:
  • Phone: 254-307-8607
  • Fax: 254-765-2501

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code251G00000X
TaxonomyCommunity Based Hospice Care Agency
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code385HR2065X
TaxonomyChild Physical Disabilities Respite Care
License Number
License Number State

VIII. Authorized Official

Name: NATASHA JAMES
Title or Position: OWNER
Credential: BSN, RN
Phone: 254-307-8607