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General NPI Number Information
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NPI Number | 1093042053
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Entity Type | Organization
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Legal Business Name | CROWN OF STARS ADC,CBA & HOME HEALTH LLC
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Dates
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Enumeration Date | 11/12/2009
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Last Update Date | 11/12/2009
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Provider Practice Location Address
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Address Line | 304 S ALAMO RD STE D 304 S ALAMO RD SUIE D
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City | ALAMO
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State | TX
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Zip | 78516-2728
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Country | US
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Telephone | 956-783-3122
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Fax | 956-783-3122
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Provider Business Mailing Address
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Address Line | 512 W EGLY AVE
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City | PHARR
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State | TX
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Zip | 78577-3726
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Country | US
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Telephone | 956-739-2031
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Fax | 956-783-3122
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Authorized Official
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Title or Position | REGISTERED NURSE
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Name | MISS DIANA SOTELO
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Credential |
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Telephone | 956-739-2031
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251E00000X
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Taxonomy Name | Home Health Agency
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 261QA0600X
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Taxonomy Name | Adult Day Care Clinic/Center
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License Number |
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License Number State |
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