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General NPI Number Information
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NPI Number | 1205919107
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Entity Type | Organization
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Legal Business Name | PRIDE HEALTH CARE SERVICES INC.
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Dates
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Enumeration Date | 10/23/2006
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Last Update Date | 02/10/2017
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Provider Practice Location Address
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Address Line | 7410 BLANCO RD STE 101
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City | SAN ANTONIO
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State | TX
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Zip | 78216
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Country | US
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Telephone | 210-366-4272
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Fax | 210-979-9953
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Provider Business Mailing Address
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Address Line | 7410 BLANCO RD STE 101
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City | SAN ANTONIO
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State | TX
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Zip | 78216-4363
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Country | US
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Telephone | 210-366-4272
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Fax | 210-979-9953
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Authorized Official
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Title or Position | PRESIDENT / ADMINISTRATOR
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Name | SANDRA J LONGORIA
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Credential | LVN
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Telephone | 210-366-4272
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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 | 015756
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License Number State | TX
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Taxonomy #2
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Taxonomy Code | 253Z00000X
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Taxonomy Name | In Home Supportive Care Agency
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License Number | 015756
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License Number State | TX
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Taxonomy #3
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Taxonomy Code | 251E00000X
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Taxonomy Name | Home Health Agency
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License Number | 008962
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License Number State | TX
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