Provider Demographics
NPI:1124159959
Name:PROFESSIONAL CARE HOME HEALTH INC
Entity type:Organization
Organization Name:PROFESSIONAL CARE HOME HEALTH INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MS
Authorized Official - First Name:LARA
Authorized Official - Middle Name:ELIZABETH
Authorized Official - Last Name:PINSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:210-342-3464
Mailing Address - Street 1:9516 CONTESSA DR
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78216-5109
Mailing Address - Country:US
Mailing Address - Phone:210-342-3464
Mailing Address - Fax:210-348-7074
Practice Address - Street 1:9516 CONTESSA DR
Practice Address - Street 2:
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78216-5109
Practice Address - Country:US
Practice Address - Phone:210-342-3464
Practice Address - Fax:210-348-7074
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-07
Last Update Date:2020-09-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes3747P1801XNursing Service Related ProvidersTechnicianPersonal Care AttendantGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX000699600Medicaid
TX001001135Medicaid