MEDICARE: SAN JOSE HOME HEALTH 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	251E00000X	Home Health Agency	010699	TX

General Provider Information

NPI Number	:	1588606057
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SAN JOSE HOME HEALTH CARE, LLC

Provider Business Mailing Address
First Line	:	102 LAKE GENEVA
Second Line	:
City	:	LAREDO
State	:	TX
Zip	:	78041-6335
Country	:	US
Telephone Number	:	956-728-8424
Fax Number	:	956-728-8426

Provider Business Practice Location Address
First Line	:	102 LAKE GENEVA DR
Second Line	:
City	:	LAREDO
State	:	TX
Zip	:	78041-1918
Country	:	US
Telephone Number	:	956-728-8424
Fax Number	:	956-728-8426

Authorized Official
Title or Position	:	ADMINISTRATOR
Name	:	MRS. CLAUDIA G MUNOZ
Credential	:	B.A.
Telephone Number	:	956-728-8424

Provider Enumeration Date	:	06/11/2006
Last Update Date	:	06/01/2012

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