MEDICARE: SANTA TERESA PROVIDER ASSISTED SERVICES LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	163W00000X	Registered Nurse	623430	TX
2	385H00000X	Respite Care
3	251E00000X	Home Health Agency	011110	TX

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	011110	OTHER	TX	TEXAS DEPT OF AGING AND D

General Provider Information

NPI Number	:	1134303043
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SANTA TERESA PROVIDER ASSISTED SERVICES LLC

Provider Business Mailing Address
First Line	:	9440 VISCOUNT BLVD STE 210
Second Line	:
City	:	EL PASO
State	:	TX
Zip	:	79925-7054
Country	:	US
Telephone Number	:	915-217-8307
Fax Number	:	915-219-8271

Provider Business Practice Location Address
First Line	:	9440 VISCOUNT BLVD STE 210
Second Line	:
City	:	EL PASO
State	:	TX
Zip	:	79925-7054
Country	:	US
Telephone Number	:	915-217-8307
Fax Number	:	915-219-8271

Authorized Official
Title or Position	:	OWNER/ADMINISTRATOR
Name	:	ENGRACIA DEL ROCIO VAZQUEZ
Credential	:
Telephone Number	:	915-217-8307

Provider Enumeration Date	:	12/27/2007
Last Update Date	:	09/01/2021

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Directions to “SANTA TERESA PROVIDER ASSISTED SERVICES LLC ” Practice Location

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