MEDICARE: CASA TRINIDAD IN HOME CARE 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	3747P1801X	Personal Care Attendant

General Provider Information

NPI Number	:	1265287361
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	CASA TRINIDAD IN HOME CARE LLC

Provider Business Mailing Address
First Line	:	3315 BURKE RD STE 240B
Second Line	:
City	:	PASADENA
State	:	TX
Zip	:	77504-1823
Country	:	US
Telephone Number	:	832-672-6648
Fax Number	:	832-672-6312

Provider Business Practice Location Address
First Line	:	3315 BURKE RD STE 240B
Second Line	:
City	:	PASADENA
State	:	TX
Zip	:	77504-1823
Country	:	US
Telephone Number	:	832-672-6648
Fax Number	:	832-672-6312

Authorized Official
Title or Position	:	OWNER
Name	:	MARIA I ALANIZ
Credential	:
Telephone Number	:	832-672-6648

Provider Enumeration Date	:	04/22/2024
Last Update Date	:	04/22/2024

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