MEDICARE: PROVEEDORAS DE LUZ HOME HEALTH, LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy
1	372500000X	Chore Provider
2	3747P1801X	Personal Care Attendant
3	253Z00000X	In Home Supportive Care Agency
4	251E00000X	Home Health Agency

General Provider Information

NPI Number	:	1053042465
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	PROVEEDORAS DE LUZ HOME HEALTH, LLC

Provider Business Mailing Address
First Line	:	9101 DYER ST STE 202
Second Line	:
City	:	EL PASO
State	:	TX
Zip	:	79924-6434
Country	:	US
Telephone Number	:	915-444-8877
Fax Number	:	915-444-8876

Provider Business Practice Location Address
First Line	:	9101 DYER ST STE 202
Second Line	:
City	:	EL PASO
State	:	TX
Zip	:	79924-6434
Country	:	US
Telephone Number	:	915-444-8877
Fax Number	:	915-444-8876

Authorized Official
Title or Position	:	MEMBER MANAGER
Name	:	TIMOTHY SELLERS
Credential	:
Telephone Number	:	915-444-8877

Provider Enumeration Date	:	06/17/2022
Last Update Date	:	03/06/2026

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