Provider Demographics
NPI:1912996026
Name:WAGGONER AND THOMAS ALL CARE INC
Entity type:Organization
Organization Name:WAGGONER AND THOMAS ALL CARE INC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CEO/OWNER/ADMINISTRATOR
Authorized Official - Prefix:MS
Authorized Official - First Name:HASKELENE
Authorized Official - Middle Name:
Authorized Official - Last Name:THOMAS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:210-363-8805
Mailing Address - Street 1:4606 CENTERVIEW
Mailing Address - Street 2:SUITE 165
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78228-1214
Mailing Address - Country:US
Mailing Address - Phone:210-348-8805
Mailing Address - Fax:210-348-8861
Practice Address - Street 1:4606 CENTERVIEW
Practice Address - Street 2:SUITE B 165
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78228-1214
Practice Address - Country:US
Practice Address - Phone:210-348-8805
Practice Address - Fax:210-348-8861
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-10-20
Last Update Date:2013-03-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX008105251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX164353801Medicaid
TX164353801Medicaid