Provider Demographics
NPI:1467702282
Name:HOME HEALTH LA MONSERRATE, INC
Entity Type:Organization
Organization Name:HOME HEALTH LA MONSERRATE, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:VICE PRESIDENT
Authorized Official - Prefix:MS
Authorized Official - First Name:MAYRA
Authorized Official - Middle Name:R
Authorized Official - Last Name:MENDEZ
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:787-873-5998
Mailing Address - Street 1:PO BOX 1263
Mailing Address - Street 2:
Mailing Address - City:AGUADA
Mailing Address - State:PR
Mailing Address - Zip Code:00602-1263
Mailing Address - Country:US
Mailing Address - Phone:787-873-5998
Mailing Address - Fax:787-873-6001
Practice Address - Street 1:100 AVE 5 DE DICIEMBRE
Practice Address - Street 2:
Practice Address - City:SABANA GRANDE
Practice Address - State:PR
Practice Address - Zip Code:00637-1961
Practice Address - Country:US
Practice Address - Phone:787-873-5998
Practice Address - Fax:787-873-6001
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-09-19
Last Update Date:2022-12-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR12-171251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR407050OtherMEDICARE PTAN
PR39OtherLICENCIA DEL ESTADO