=====================================================
General NPI Number Information
=====================================================
NPI Number | 1649090960
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | ECC HOME
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 10/11/2024
-----------------------------------------------------
Last Update Date | 10/11/2024
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 4218 PARKWOOD DR
-----------------------------------------------------
City | SAN ANTONIO
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 78218-5024
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 210-982-2230
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 4218 PARKWOOD DR
-----------------------------------------------------
City | SAN ANTONIO
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 78218-5024
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 210-982-2230
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | CHIEF OPERATING OFFICER
-----------------------------------------------------
Name | EBONY MILLSAP
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 210-982-2230
-----------------------------------------------------
=====================================================
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 | 3747P1801X
-----------------------------------------------------
Taxonomy Name | Personal Care Attendant
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------