Provider Demographics
NPI:1225615099
Name:MANNA HOME PROVIDER SERVICES, LLC
Entity Type:Organization
Organization Name:MANNA HOME PROVIDER SERVICES, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:DAMARIS
Authorized Official - Middle Name:
Authorized Official - Last Name:GONZALEZ
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:361-438-7038
Mailing Address - Street 1:5151 FLYNN PKWY STE 412T
Mailing Address - Street 2:
Mailing Address - City:CORPUS CHRISTI
Mailing Address - State:TX
Mailing Address - Zip Code:78411-4367
Mailing Address - Country:US
Mailing Address - Phone:361-688-1586
Mailing Address - Fax:
Practice Address - Street 1:5151 FLYNN PKWY STE 412T
Practice Address - Street 2:
Practice Address - City:CORPUS CHRISTI
Practice Address - State:TX
Practice Address - Zip Code:78411-4367
Practice Address - Country:US
Practice Address - Phone:361-688-1586
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-03-26
Last Update Date:2021-10-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes3747P1801XNursing Service Related ProvidersTechnicianPersonal Care AttendantGroup - Single Specialty