MEDICARE: AHOME HEART PROVIDER 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	3747P1801X	Personal Care Attendant

General Provider Information

NPI Number	:	1750170932
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	AHOME HEART PROVIDER SERVICES, LLC

Provider Business Mailing Address
First Line	:	1119 W MAYFIELD BLVD
Second Line	:
City	:	SAN ANTONIO
State	:	TX
Zip	:	78211-2941
Country	:	US
Telephone Number	:	210-364-2272
Fax Number	:	210-634-2525

Provider Business Practice Location Address
First Line	:	1119 W MAYFIELD BLVD
Second Line	:
City	:	SAN ANTONIO
State	:	TX
Zip	:	78211-2941
Country	:	US
Telephone Number	:	210-364-2272
Fax Number	:	210-634-2525

Authorized Official
Title or Position	:	ADMINISTRATOR
Name	:	GLADIS NAZARIO
Credential	:
Telephone Number	:	210-364-2272

Provider Enumeration Date	:	05/05/2025
Last Update Date	:	05/05/2025

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Directions to “AHOME HEART PROVIDER SERVICES, LLC ” Practice Location

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