Provider Demographics
NPI:1144511569
Name:NATIONAL INDEPENDENT SENIORCARE
Entity type:Organization
Organization Name:NATIONAL INDEPENDENT SENIORCARE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR OF OPERATIONS
Authorized Official - Prefix:MRS
Authorized Official - First Name:JEANETTE
Authorized Official - Middle Name:
Authorized Official - Last Name:IBARRA
Authorized Official - Suffix:
Authorized Official - Credentials:BA
Authorized Official - Phone:210-822-2654
Mailing Address - Street 1:1635 NE LOOP 410
Mailing Address - Street 2:SUITE 700
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78209-1620
Mailing Address - Country:US
Mailing Address - Phone:210-822-2654
Mailing Address - Fax:210-822-2982
Practice Address - Street 1:5656 S. STAPLES ST.
Practice Address - Street 2:SUITE 210
Practice Address - City:CORPUS CHRISTI
Practice Address - State:TX
Practice Address - Zip Code:78411-4655
Practice Address - Country:US
Practice Address - Phone:361-225-3492
Practice Address - Fax:361-225-4409
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-04-20
Last Update Date:2014-04-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
251E00000X
TX014309253Z00000X, 251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
No253Z00000XAgenciesIn Home Supportive Care