Provider Demographics
NPI:1528139888
Name:COLONIAL HOME HEALTH, INC.
Entity type:Organization
Organization Name:COLONIAL HOME HEALTH, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MR
Authorized Official - First Name:VICTOR
Authorized Official - Middle Name:
Authorized Official - Last Name:CAMILO
Authorized Official - Suffix:
Authorized Official - Credentials:RN
Authorized Official - Phone:210-225-1115
Mailing Address - Street 1:2735 NACOGDOCHES RD
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78217-5830
Mailing Address - Country:US
Mailing Address - Phone:210-225-1115
Mailing Address - Fax:210-225-1114
Practice Address - Street 1:2735 NACOGDOCHES RD
Practice Address - Street 2:
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78217-5830
Practice Address - Country:US
Practice Address - Phone:210-225-1115
Practice Address - Fax:210-225-1114
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-10
Last Update Date:2018-09-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
376J00000X, 385H00000X, 251J00000X, 373H00000X, 3747P1801X, 253Z00000X, 372600000X, 374U00000X
TX007963251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes251E00000XAgenciesHome Health
No376J00000XNursing Service Related ProvidersHomemakerGroup - Multi-Specialty
No385H00000XRespite Care FacilityRespite Care
No251J00000XAgenciesNursing CareGroup - Multi-Specialty
No373H00000XNursing Service Related ProvidersDay Training/Habilitation SpecialistGroup - Multi-Specialty
No3747P1801XNursing Service Related ProvidersTechnicianPersonal Care AttendantGroup - Multi-Specialty
No253Z00000XAgenciesIn Home Supportive CareGroup - Multi-Specialty
No372600000XNursing Service Related ProvidersAdult CompanionGroup - Multi-Specialty
No374U00000XNursing Service Related ProvidersHome Health AideGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX186870501Medicaid