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General NPI Number Information
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NPI Number | 1487984126
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Entity Type | Organization
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Legal Business Name | LUZ DIVINA HOME CARE AGENCY
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Dates
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Enumeration Date | 12/31/2009
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Last Update Date | 12/31/2009
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Provider Practice Location Address
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Address Line | 236 N 15TH ST
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City | ALLENTOWN
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State | PA
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Zip | 18102-3673
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Country | US
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Telephone | 610-437-2220
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Fax | 610-437-2276
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Provider Business Mailing Address
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Address Line | 236 N 15TH ST
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City | ALLENTOWN
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State | PA
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Zip | 18102-3673
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Country | US
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Telephone | 610-437-2220
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Fax | 610-437-2276
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Authorized Official
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Title or Position | ADMINISTRATOR
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Name | MR. ANGEL PORTORREAL
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Credential | AAS
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Telephone | 610-618-0557
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 311ZA0620X
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Taxonomy Name | Adult Care Home Facility
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License Number |
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License Number State |
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