MEDICARE: COLONIAL HOME HEALTH, INC.

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	376J00000X	Homemaker
2	385H00000X	Respite Care
3	251J00000X	Nursing Care Agency
4	373H00000X	Day Training/Habilitation Specialist
5	3747P1801X	Personal Care Attendant
6	253Z00000X	In Home Supportive Care Agency
7	372600000X	Adult Companion
8	374U00000X	Home Health Aide
9	251E00000X	Home Health Agency	007963	TX

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1528139888
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	COLONIAL HOME HEALTH, INC.

Provider Business Mailing Address
First Line	:	2735 NACOGDOCHES RD
Second Line	:
City	:	SAN ANTONIO
State	:	TX
Zip	:	78217-5830
Country	:	US
Telephone Number	:	210-225-1115
Fax Number	:	210-225-1114

Provider Business Practice Location Address
First Line	:	2735 NACOGDOCHES RD
Second Line	:
City	:	SAN ANTONIO
State	:	TX
Zip	:	78217-5830
Country	:	US
Telephone Number	:	210-225-1115
Fax Number	:	210-225-1114

Authorized Official
Title or Position	:	ADMINISTRATOR
Name	:	MR. VICTOR CAMILO
Credential	:	R.N.
Telephone Number	:	210-225-1115

Provider Enumeration Date	:	11/10/2006
Last Update Date	:	09/14/2018

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Directions to “COLONIAL HOME HEALTH, INC. ” Practice Location

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