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General NPI Number Information
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NPI Number | 1508066523
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Entity Type | Organization
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Legal Business Name | LA BUENA SALUD HOME HEALTH, LLC
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Dates
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Enumeration Date | 07/18/2007
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Last Update Date | 10/02/2007
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Provider Practice Location Address
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Address Line | 627 N KING ST STE 4
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City | ALICE
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State | TX
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Zip | 78332-4660
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Country | US
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Telephone | 361-664-7171
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Fax | 361-664-7174
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Provider Business Mailing Address
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Address Line | 627 N KING ST STE 4
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City | ALICE
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State | TX
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Zip | 78332-4660
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Country | US
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Telephone | 361-664-7171
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Fax | 361-664-7174
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Authorized Official
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Title or Position | OWNER/ADMINISTRATOR
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Name | MR. LORENZO MONCEVAIS III
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Credential |
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Telephone | 361-664-7171
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251E00000X
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Taxonomy Name | Home Health Agency
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License Number |
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License Number State |
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