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General NPI Number Information
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NPI Number | 1356756787
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Entity Type | Organization
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Legal Business Name | COLVIN HOME HEALTH & CONSULTATIVE SERVICES
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Dates
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Enumeration Date | 06/24/2014
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Last Update Date | 06/24/2014
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Provider Practice Location Address
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Address Line | 120 WINDING PATH
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City | BOERNE
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State | TX
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Zip | 78006-8628
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Country | US
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Telephone | 210-833-1861
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Fax |
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Provider Business Mailing Address
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Address Line | 120 WINDING PATH
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City | BOERNE
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State | TX
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Zip | 78006-8628
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Country | US
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Telephone | 210-833-1861
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Fax |
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Authorized Official
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Title or Position | OWNER/OCCUPATIONAL THERAPIST
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Name | JENNICA NICOLE COLVIN
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Credential | O.T.
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Telephone | 210-833-1861
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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 | 110631
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License Number State | TX
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