Provider Demographics
NPI:1386973360
Name:ANTHEM HEALTHCARE, INC.
Entity type:Organization
Organization Name:ANTHEM HEALTHCARE, INC.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:RODOLFO
Authorized Official - Middle Name:ENRIQUE
Authorized Official - Last Name:VILLALPANDO
Authorized Official - Suffix:JR
Authorized Official - Credentials:
Authorized Official - Phone:830-776-7068
Mailing Address - Street 1:1615 VETERANS BLVD
Mailing Address - Street 2:
Mailing Address - City:EAGLE PASS
Mailing Address - State:TX
Mailing Address - Zip Code:78852-6480
Mailing Address - Country:US
Mailing Address - Phone:830-776-7068
Mailing Address - Fax:866-571-0395
Practice Address - Street 1:1615 VETERANS BLVD
Practice Address - Street 2:
Practice Address - City:EAGLE PASS
Practice Address - State:TX
Practice Address - Zip Code:78852-6134
Practice Address - Country:US
Practice Address - Phone:830-776-7068
Practice Address - Fax:866-571-0395
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-12-21
Last Update Date:2024-06-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX013388251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX339480101Medicaid
TX339480101Medicaid