Basic Information
Provider Information
NPI: 1942209275
EntityType: 2
ReplacementNPI:  
OrganizationName: AFTERCARE VISITING NURSE SERVICE,LLC
LastName:  
FirstName:  
MiddleName:  
NamePrefix:  
NameSuffix:  
Credential:  
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: PO BOX 1129
Address2: 106 N. GRACE
City: CROCKETT
State: TX
PostalCode: 758351129
CountryCode: US
TelephoneNumber: 9365447202
FaxNumber: 9365462029
Practice Location
Address1: 106 N GRACE ST
Address2:  
City: CROCKETT
State: TX
PostalCode: 758351722
CountryCode: US
TelephoneNumber: 9365447202
FaxNumber: 9365462029
Other Information
ProviderEnumerationDate: 07/19/2005
LastUpdateDate: 08/22/2020
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode:  
AuthorizedOfficialLastName: HORNE
AuthorizedOfficialFirstName: CYNTHIA
AuthorizedOfficialMiddleName: R
AuthorizedOfficialTitleorPosition: OWNER/ADMINISTRTOR
AuthorizedOfficialTelephone: 9365447202
IsSoleProprietor:  
IsOrganizationSubpart: N
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix: MS.
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential: RN, BSN
NPICertificationDate:  

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
251E00000X05441TXY AgenciesHome Health 

ID Information
IDTypeStateIssuerDescription
0544101TXSTATE LICENSEOTHER


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