=====================================================
General NPI Number Information
=====================================================
NPI Number | 1902986110
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | ASCENSIA HOME HEALTH, INC.
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 10/16/2006
-----------------------------------------------------
Last Update Date | 07/27/2020
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1633 W KINGS HWY
-----------------------------------------------------
City | SAN ANTONIO
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 78201-5004
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 210-521-0575
-----------------------------------------------------
Fax | 210-521-0574
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 1633 W KINGS HWY
-----------------------------------------------------
City | SAN ANTONIO
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 78201-5004
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 210-521-0575
-----------------------------------------------------
Fax | 210-521-0574
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | ADMINISTRATOR
-----------------------------------------------------
Name | MRS. ADRIANA MARIE BROWN
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 210-521-0575
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 251E00000X
-----------------------------------------------------
Taxonomy Name | Home Health Agency
-----------------------------------------------------
License Number | 010297
-----------------------------------------------------
License Number State | TX
-----------------------------------------------------