=====================================================
General NPI Number Information
=====================================================
NPI Number | 1376618223
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | MONARCA HOME HEALTH, INC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 11/22/2006
-----------------------------------------------------
Last Update Date | 08/07/2007
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 6323 STABLE DOWNS
-----------------------------------------------------
City | SAN ANTONIO
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 78249-4611
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 210-699-0300
-----------------------------------------------------
Fax | 866-821-9394
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 6323 STABLE DOWNS
-----------------------------------------------------
City | SAN ANTONIO
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 78249-4611
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 210-699-0300
-----------------------------------------------------
Fax | 866-821-9394
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | ADMINISTRATOR
-----------------------------------------------------
Name | MR. RAPHAEL HERNANDEZ
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 210-577-9600
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 251E00000X
-----------------------------------------------------
Taxonomy Name | Home Health Agency
-----------------------------------------------------
License Number | 010883
-----------------------------------------------------
License Number State | TX
-----------------------------------------------------