Provider Demographics
NPI:1053042465
Name:PROVEEDORAS DE LUZ HOME HEALTH, LLC
Entity Type:Organization
Organization Name:PROVEEDORAS DE LUZ HOME HEALTH, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEMBER MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:TIMOTHY
Authorized Official - Middle Name:
Authorized Official - Last Name:SELLERS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:915-444-8877
Mailing Address - Street 1:9101 DYER ST STE 202
Mailing Address - Street 2:
Mailing Address - City:EL PASO
Mailing Address - State:TX
Mailing Address - Zip Code:79924-6434
Mailing Address - Country:US
Mailing Address - Phone:915-444-8877
Mailing Address - Fax:915-444-8876
Practice Address - Street 1:9101 DYER ST STE 202
Practice Address - Street 2:
Practice Address - City:EL PASO
Practice Address - State:TX
Practice Address - Zip Code:79924-6434
Practice Address - Country:US
Practice Address - Phone:915-444-8877
Practice Address - Fax:915-444-8876
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-06-17
Last Update Date:2023-05-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes251E00000XAgenciesHome HealthGroup - Multi-Specialty
No372500000XNursing Service Related ProvidersChore ProviderGroup - Multi-Specialty
No3747P1801XNursing Service Related ProvidersTechnicianPersonal Care AttendantGroup - Multi-Specialty