Provider Demographics
NPI:1558459248
Name:PRIMAVERA HOME HEALTH, P.C.
Entity Type:Organization
Organization Name:PRIMAVERA HOME HEALTH, P.C.
Other - Org Name:PRIMAVERA HOME HEALTH PC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:SANDRA
Authorized Official - Middle Name:LUZ
Authorized Official - Last Name:MORENO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:915-771-8282
Mailing Address - Street 1:2829 MONTANA AVE STE 210
Mailing Address - Street 2:
Mailing Address - City:EL PASO
Mailing Address - State:TX
Mailing Address - Zip Code:79903-2431
Mailing Address - Country:US
Mailing Address - Phone:915-771-8282
Mailing Address - Fax:915-771-8989
Practice Address - Street 1:2829 MONTANA AVE STE 210
Practice Address - Street 2:
Practice Address - City:EL PASO
Practice Address - State:TX
Practice Address - Zip Code:79903-2431
Practice Address - Country:US
Practice Address - Phone:915-771-8282
Practice Address - Fax:915-771-8989
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-10
Last Update Date:2021-11-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX010611251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX159704901Medicaid
TX679299Medicare ID - Type Unspecified