Provider Demographics
NPI:1407000631
Name:MI PUEBLO HOME HEALTH CARE, LLC
Entity Type:Organization
Organization Name:MI PUEBLO HOME HEALTH CARE, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:MARISOL
Authorized Official - Middle Name:N
Authorized Official - Last Name:GONZALEZ
Authorized Official - Suffix:
Authorized Official - Credentials:REGISTERED NURSE
Authorized Official - Phone:956-437-5654
Mailing Address - Street 1:P.O. BOX 14998
Mailing Address - Street 2:2002 LINCOLN ST.
Mailing Address - City:ZAPATA
Mailing Address - State:TX
Mailing Address - Zip Code:78076-3563
Mailing Address - Country:US
Mailing Address - Phone:956-765-0088
Mailing Address - Fax:956-765-0099
Practice Address - Street 1:2002 LINCOLN ST
Practice Address - Street 2:
Practice Address - City:ZAPATA
Practice Address - State:TX
Practice Address - Zip Code:78076-3563
Practice Address - Country:US
Practice Address - Phone:956-765-0088
Practice Address - Fax:956-765-0099
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-11-14
Last Update Date:2008-11-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health