MEDICARE: NUEVO HOGAR EAST LLC

Medicare Provider Information

Scope of Practice

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

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	253Z00000X	In Home Supportive Care Agency

General Provider Information

NPI Number	:	1487191789
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	NUEVO HOGAR EAST LLC

Provider Business Mailing Address
First Line	:	1031 E RIO GRANDE AVE
Second Line	:
City	:	EL PASO
State	:	TX
Zip	:	79902-4656
Country	:	US
Telephone Number	:	210-849-5788
Fax Number	:

Provider Business Practice Location Address
First Line	:	1031 E RIO GRANDE AVE
Second Line	:
City	:	EL PASO
State	:	TX
Zip	:	79902-4656
Country	:	US
Telephone Number	:	210-849-5788
Fax Number	:

Authorized Official
Title or Position	:	AGENCY ADMINISTRATOR
Name	:	ANA MARLENE RIOS
Credential	:
Telephone Number	:	210-849-5788

Provider Enumeration Date	:	01/24/2017
Last Update Date	:	01/24/2017

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