=====================================================
General NPI Number Information
=====================================================
NPI Number | 1073767349
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | REGAIN HOME HEALTH INC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 11/12/2008
-----------------------------------------------------
Last Update Date | 09/09/2013
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 109 GROTTO BLVD
-----------------------------------------------------
City | SAN ANTONIO
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 78216
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 210-781-2002
-----------------------------------------------------
Fax | 210-764-5471
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 511 JACKSON KELLER RD SUITE A
-----------------------------------------------------
City | SAN ANTONIO
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 78216-7120
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 210-781-2002
-----------------------------------------------------
Fax | 210-764-5471
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | ADMINISTRATOR
-----------------------------------------------------
Name | ENRIQUE H CUENTAS
-----------------------------------------------------
Credential | RN
-----------------------------------------------------
Telephone | 210-781-2002
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 253Z00000X
-----------------------------------------------------
Taxonomy Name | In Home Supportive Care Agency
-----------------------------------------------------
License Number | 014442
-----------------------------------------------------
License Number State | TX
-----------------------------------------------------