=====================================================
General NPI Number Information
=====================================================
NPI Number | 1598990608
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | MORA'S HOME CARE, INC.
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 05/19/2009
-----------------------------------------------------
Last Update Date | 10/14/2015
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 3228 SOUTHERN DR 203-C
-----------------------------------------------------
City | GARLAND
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 75043-1579
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 972-658-6756
-----------------------------------------------------
Fax | 972-479-8860
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 3228 SOUTHERN DR STE 203C
-----------------------------------------------------
City | GARLAND
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 75043-1579
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 972-658-6756
-----------------------------------------------------
Fax | 972-479-8860
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | ADMINISTRATOR
-----------------------------------------------------
Name | MS. HALIMA PATRICIA CASTILLO
-----------------------------------------------------
Credential | C.N.A.
-----------------------------------------------------
Telephone | 972-658-6756
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 253Z00000X
-----------------------------------------------------
Taxonomy Name | In Home Supportive Care Agency
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 251E00000X
-----------------------------------------------------
Taxonomy Name | Home Health Agency
-----------------------------------------------------
License Number | 012847
-----------------------------------------------------
License Number State | TX
-----------------------------------------------------