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General NPI Number Information
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NPI Number | 1740681683
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Entity Type | Organization
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Legal Business Name | OHANA PEDIATRIC HOME HEALTH, LLC
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Dates
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Enumeration Date | 09/10/2014
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Last Update Date | 06/03/2015
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Provider Practice Location Address
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Address Line | 26421 INTERSTATE 10 W
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City | BOERNE
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State | TX
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Zip | 78006-6500
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Country | US
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Telephone | 210-451-8555
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Fax | 210-451-8554
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Provider Business Mailing Address
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Address Line | 26421 INTERSTATE 10 W
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City | BOERNE
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State | TX
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Zip | 78006-6500
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Country | US
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Telephone | 210-451-8555
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Fax | 210-451-8554
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Authorized Official
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Title or Position | CEO
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Name | MR. DWIGHT PETERSON
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Credential |
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Telephone | 210-451-8555
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251J00000X
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Taxonomy Name | Nursing Care Agency
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 251E00000X
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Taxonomy Name | Home Health Agency
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License Number |
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License Number State |
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