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General NPI Number Information
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NPI Number | 1295921203
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Entity Type | Organization
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Legal Business Name | CC HOME HEALTH LUBBOCK, LLC
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Dates
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Enumeration Date | 09/24/2007
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Last Update Date | 02/01/2023
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Provider Practice Location Address
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Address Line | 2118 BROADWAY
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City | LUBBOCK
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State | TX
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Zip | 79401-2913
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Country | US
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Telephone | 806-785-7903
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Fax | 806-785-7918
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Provider Business Mailing Address
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Address Line | 1110 N CARROLL AVE
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City | SOUTHLAKE
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State | TX
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Zip | 76092-5306
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Country | US
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Telephone | 817-310-1100
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Fax | 817-310-1197
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Authorized Official
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Title or Position | CEO
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Name | DR. CARMEN SANTIAGO
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Credential | DRPH
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Telephone | 817-310-1100
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251G00000X
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Taxonomy Name | Community Based Hospice Care Agency
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License Number | 007152
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License Number State | TX
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