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General NPI Number Information
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NPI Number | 1275861718
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Entity Type | Organization
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Legal Business Name | ST MARYS PEDIATRIC HOMECARE, INC.
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Dates
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Enumeration Date | 11/20/2009
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Last Update Date | 11/20/2009
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Provider Practice Location Address
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Address Line | 4203 GARDENDALE ST SUITE C 200
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City | SAN ANTONIO
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State | TX
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Zip | 78229-3174
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Country | US
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Telephone | 210-710-0588
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Fax | 210-455-7423
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Provider Business Mailing Address
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Address Line | 4203 GARDENDALE ST SUITE C 200
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City | SAN ANTONIO
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State | TX
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Zip | 78229-3174
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Country | US
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Telephone | 210-710-0588
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Fax | 210-455-7423
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Authorized Official
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Title or Position | COO
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Name | EDWARD PENA
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Credential |
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Telephone | 210-710-0588
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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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