=====================================================
General NPI Number Information
=====================================================
NPI Number | 1790043941
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | TOUCHED BY AN ANGEL HOME CARE INC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 04/25/2012
-----------------------------------------------------
Last Update Date | 05/24/2024
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 5102 BENGO BAY
-----------------------------------------------------
City | LAREDO
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 78041
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 956-337-0136
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 5102 BENGO BAY
-----------------------------------------------------
City | LAREDO
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 78041
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 956-337-0136
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | RN/BSN
-----------------------------------------------------
Name | MRS. CARMEN GRISELDA CEPEDA
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 956-337-0136
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 385H00000X
-----------------------------------------------------
Taxonomy Name | Respite Care
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 251B00000X
-----------------------------------------------------
Taxonomy Name | Case Management Agency
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------
Taxonomy #3
-----------------------------------------------------
Taxonomy Code | 3747P1801X
-----------------------------------------------------
Taxonomy Name | Personal Care Attendant
-----------------------------------------------------
License Number | G53125
-----------------------------------------------------
License Number State | TX
-----------------------------------------------------