=====================================================
General NPI Number Information
=====================================================
NPI Number | 1780744672
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | SANDS CARE HEALTH SERVICES, L.C.
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 12/11/2006
-----------------------------------------------------
Last Update Date | 06/24/2022
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 201 W HILLSIDE RD STE 8
-----------------------------------------------------
City | LAREDO
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 78041-6905
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 956-728-1565
-----------------------------------------------------
Fax | 956-728-1566
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 201 W HILLSIDE RD STE 8
-----------------------------------------------------
City | LAREDO
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 78041-6905
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 956-728-1565
-----------------------------------------------------
Fax | 956-728-1566
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | ADMINISTRATOR
-----------------------------------------------------
Name | MRS. ANDREA L. SANDS
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 956-728-1565
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 251C00000X
-----------------------------------------------------
Taxonomy Name | Developmentally Disabled Services Day Training Agency
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 251E00000X
-----------------------------------------------------
Taxonomy Name | Home Health Agency
-----------------------------------------------------
License Number | 007687
-----------------------------------------------------
License Number State | TX
-----------------------------------------------------