Provider Demographics
NPI:1194925941
Name:SACRED HEART SPECIALTY HOME CARE, LLC
Entity type:Organization
Organization Name:SACRED HEART SPECIALTY HOME CARE, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR/D.O.N.
Authorized Official - Prefix:MISS
Authorized Official - First Name:MATILDE
Authorized Official - Middle Name:S
Authorized Official - Last Name:LONGORIA
Authorized Official - Suffix:
Authorized Official - Credentials:RN
Authorized Official - Phone:361-227-8649
Mailing Address - Street 1:PO BOX 462
Mailing Address - Street 2:
Mailing Address - City:ALICE
Mailing Address - State:TX
Mailing Address - Zip Code:78333-0462
Mailing Address - Country:US
Mailing Address - Phone:361-668-0353
Mailing Address - Fax:361-668-2500
Practice Address - Street 1:614 W 5TH ST
Practice Address - Street 2:
Practice Address - City:ALICE
Practice Address - State:TX
Practice Address - Zip Code:78332-4401
Practice Address - Country:US
Practice Address - Phone:361-668-0353
Practice Address - Fax:361-668-2500
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-07-20
Last Update Date:2007-07-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health