Provider Demographics
NPI:1508066523
Name:LA BUENA SALUD HOME HEALTH, LLC
Entity Type:Organization
Organization Name:LA BUENA SALUD HOME HEALTH, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/ADMINISTRATOR
Authorized Official - Prefix:MR
Authorized Official - First Name:LORENZO
Authorized Official - Middle Name:
Authorized Official - Last Name:MONCEVAIS
Authorized Official - Suffix:III
Authorized Official - Credentials:
Authorized Official - Phone:361-664-7171
Mailing Address - Street 1:627 N KING ST STE 4
Mailing Address - Street 2:
Mailing Address - City:ALICE
Mailing Address - State:TX
Mailing Address - Zip Code:78332-4660
Mailing Address - Country:US
Mailing Address - Phone:361-664-7171
Mailing Address - Fax:361-664-7174
Practice Address - Street 1:627 N KING ST STE 4
Practice Address - Street 2:
Practice Address - City:ALICE
Practice Address - State:TX
Practice Address - Zip Code:78332-4660
Practice Address - Country:US
Practice Address - Phone:361-664-7171
Practice Address - Fax:361-664-7174
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-07-18
Last Update Date:2007-10-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX677947Medicare PIN
TX677947Medicare Oscar/Certification