| Organization Name: | WEST SIDE PRIMARY HOME CARE INC |
| NPI Number: | 1609165935 |
| Entity Type Code: | Organizational (2) |
| Authorized Official Name: | EDNA VERNETTE CARRANZA (ADMINISTRATOR/OWNER) |
| Mailing Address: | 539 N General Mcmullen Dr Suite 106 San Antonio |
| State: | TX US |
| Postal Code: | 782286262 |
| Phone Number: | 2104333133 |
| Fax Number: | 2104333177 |
| NPI Enumeration Date: | 04/07/2011 |
| NPI Last Update Date: | 04/07/2011 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 253Z00000X |
| License Number: | |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | |
| Taxonomy Type: | Agencies |
| Taxonomy Classification: | In Home Supportive Care |
| Taxonomy Specialization: | |
| Taxonomy Definition: | An In Home Supportive Care Agency provides services in the patient |