Provider Demographics
NPI:1063613388
Name:SANTA FE HOME CARE LLC
Entity type:Organization
Organization Name:SANTA FE HOME CARE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:JULISSA
Authorized Official - Middle Name:G
Authorized Official - Last Name:SEANEZ
Authorized Official - Suffix:
Authorized Official - Credentials:RN
Authorized Official - Phone:915-845-3900
Mailing Address - Street 1:611 NEWMAN ST
Mailing Address - Street 2:
Mailing Address - City:EL PASO
Mailing Address - State:TX
Mailing Address - Zip Code:79902-5513
Mailing Address - Country:US
Mailing Address - Phone:915-845-3900
Mailing Address - Fax:915-845-3901
Practice Address - Street 1:611 NEWMAN ST
Practice Address - Street 2:
Practice Address - City:EL PASO
Practice Address - State:TX
Practice Address - Zip Code:79902
Practice Address - Country:US
Practice Address - Phone:915-845-3900
Practice Address - Fax:915-845-3901
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:SANTA FE HOME CARE LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2007-05-31
Last Update Date:2024-07-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
251C00000X, 253Z00000X, 3747P1801X
TX009195251J00000X, 251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes251E00000XAgenciesHome HealthGroup - Multi-Specialty
No251C00000XAgenciesDay Training, Developmentally Disabled Services
No251J00000XAgenciesNursing Care
No253Z00000XAgenciesIn Home Supportive Care
No3747P1801XNursing Service Related ProvidersTechnicianPersonal Care AttendantGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX001014474Medicaid