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General NPI Number Information
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NPI Number | 1194925941
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Entity Type | Organization
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Legal Business Name | SACRED HEART SPECIALTY HOME CARE, LLC
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Dates
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Enumeration Date | 07/20/2007
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Last Update Date | 07/20/2007
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Provider Practice Location Address
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Address Line | 614 W 5TH ST
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City | ALICE
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State | TX
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Zip | 78332-4401
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Country | US
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Telephone | 361-668-0353
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Fax | 361-668-2500
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Provider Business Mailing Address
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Address Line | PO BOX 462
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City | ALICE
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State | TX
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Zip | 78333-0462
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Country | US
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Telephone | 361-668-0353
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Fax | 361-668-2500
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Authorized Official
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Title or Position | ADMINISTRATOR/D.O.N.
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Name | MISS MATILDE S LONGORIA
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Credential | RN
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Telephone | 361-227-8649
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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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