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General NPI Number Information
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NPI Number | 1144657693
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Entity Type | Organization
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Legal Business Name | REGINA ROBERTSON
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Dates
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Enumeration Date | 09/30/2013
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Last Update Date | 09/30/2013
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Provider Practice Location Address
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Address Line | 100 E CAMERON AVE
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City | ROCKDALE
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State | TX
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Zip | 76567-2924
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Country | US
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Telephone | 512-446-2009
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Fax | 512-446-3859
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Provider Business Mailing Address
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Address Line | 100 E CAMERON AVE
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City | ROCKDALE
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State | TX
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Zip | 76567-2924
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Country | US
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Telephone | 512-446-2009
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Fax | 512-446-3859
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Authorized Official
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Title or Position | OWNER/ADMINISTRATOR
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Name | REGINA VILLANUEVA ROBERTSON
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Credential | RN
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Telephone | 254-563-6556
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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 | 014635
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License Number State | TX
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