=====================================================
General NPI Number Information
=====================================================
NPI Number | 1023336468
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | CHILD'S PLAY THERAPEUTIC HOMECARE INC.
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 05/10/2010
-----------------------------------------------------
Last Update Date | 09/19/2023
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1042 CENTRAL PARKWAY SOUTH SUITE 1042
-----------------------------------------------------
City | SAN ANTONIO
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 78232
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 210-348-7529
-----------------------------------------------------
Fax | 210-348-7527
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 400 INTERSTATE NORTH PARKWAY, SE SUITE 1600 ATTN: LICENSING
-----------------------------------------------------
City | ATLANTA
-----------------------------------------------------
State | GA
-----------------------------------------------------
Zip | 30339
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 470-464-8000
-----------------------------------------------------
Fax | 770-248-8192
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | CHIEF LEGAL OFFICER
-----------------------------------------------------
Name | SHANNON DRAKE
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 470-464-8000
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 251J00000X
-----------------------------------------------------
Taxonomy Name | Nursing Care Agency
-----------------------------------------------------
License Number | 013740
-----------------------------------------------------
License Number State | TX
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 251E00000X
-----------------------------------------------------
Taxonomy Name | Home Health Agency
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------