Provider Demographics
NPI:1316174584
Name:ST.MARK HOME HEALTH CARE, LLC
Entity type:Organization
Organization Name:ST.MARK HOME HEALTH CARE, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:TONY
Authorized Official - Middle Name:
Authorized Official - Last Name:MARTINEZ
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:956-790-9161
Mailing Address - Street 1:5845 FREDERICKSBURG RD.
Mailing Address - Street 2:205
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78229-6152
Mailing Address - Country:US
Mailing Address - Phone:210-366-2352
Mailing Address - Fax:956-729-1133
Practice Address - Street 1:5845 FREDERICKSBURG
Practice Address - Street 2:205
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78229-4559
Practice Address - Country:US
Practice Address - Phone:956-790-9161
Practice Address - Fax:956-729-1133
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-06-16
Last Update Date:2016-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX012830OtherSTATE LICENCE
TX747460Medicare Oscar/Certification