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General NPI Number Information
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NPI Number | 1609165935
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Entity Type | Organization
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Legal Business Name | WEST SIDE PRIMARY HOME CARE INC
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Dates
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Enumeration Date | 04/07/2011
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Last Update Date | 04/07/2011
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Provider Practice Location Address
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Address Line | 539 N GENERAL MCMULLEN DR SUITE 106
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City | SAN ANTONIO
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State | TX
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Zip | 78228-6262
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Country | US
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Telephone | 210-433-3133
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Fax | 210-433-3177
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Provider Business Mailing Address
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Address Line | 539 N GENERAL MCMULLEN DR SUITE 106
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City | SAN ANTONIO
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State | TX
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Zip | 78228-6262
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Country | US
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Telephone | 210-433-3133
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Fax | 210-433-3177
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Authorized Official
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Title or Position | ADMINISTRATOR/OWNER
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Name | MRS. EDNA VERNETTE CARRANZA
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Credential | MSN, RN
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Telephone | 956-723-1856
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 253Z00000X
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Taxonomy Name | In Home Supportive Care Agency
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License Number |
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License Number State |
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