Provider Demographics
NPI:1962406736
Name:HOME PREFERRED SENIOR CARE 5, LLC
Entity type:Organization
Organization Name:HOME PREFERRED SENIOR CARE 5, LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CREDENTIALING MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:JACKIE
Authorized Official - Middle Name:D
Authorized Official - Last Name:LOHN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:325-456-2574
Mailing Address - Street 1:874 HARPER RD STE 105
Mailing Address - Street 2:
Mailing Address - City:KERRVILLE
Mailing Address - State:TX
Mailing Address - Zip Code:78028-2985
Mailing Address - Country:US
Mailing Address - Phone:830-895-3100
Mailing Address - Fax:830-895-3104
Practice Address - Street 1:874 HARPER RD STE 105
Practice Address - Street 2:
Practice Address - City:KERRVILLE
Practice Address - State:TX
Practice Address - Zip Code:78028-2985
Practice Address - Country:US
Practice Address - Phone:830-895-3100
Practice Address - Fax:830-895-3104
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-06-09
Last Update Date:2022-02-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXHH8598OtherBC/BS PROVIDER NUMBER
TX001002364Medicaid
TXHH8598OtherBC/BS PROVIDER NUMBER
TXHH8598OtherBC/BS PROVIDER NUMBER
TX45Q8280001Medicare ID - Type UnspecifiedBRANCH IDENTIFICATION NUM