Provider Demographics
NPI:1578349825
Name:DESEOS DIVINOS PRIMARY HOME CARE SERVICES LLC
Entity Type:Organization
Organization Name:DESEOS DIVINOS PRIMARY HOME CARE SERVICES LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MR
Authorized Official - First Name:ERNESTO
Authorized Official - Middle Name:ALONSO
Authorized Official - Last Name:LOPEZ
Authorized Official - Suffix:JR
Authorized Official - Credentials:
Authorized Official - Phone:956-466-9493
Mailing Address - Street 1:7565 FLORIDA PINE ST
Mailing Address - Street 2:
Mailing Address - City:BROWNSVILLE
Mailing Address - State:TX
Mailing Address - Zip Code:78526-3041
Mailing Address - Country:US
Mailing Address - Phone:956-466-9493
Mailing Address - Fax:956-621-2812
Practice Address - Street 1:7565 FLORIDA PINE ST
Practice Address - Street 2:
Practice Address - City:BROWNSVILLE
Practice Address - State:TX
Practice Address - Zip Code:78526-3041
Practice Address - Country:US
Practice Address - Phone:956-466-9493
Practice Address - Fax:956-621-2812
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-09-04
Last Update Date:2023-10-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes3747P1801XNursing Service Related ProvidersTechnicianPersonal Care AttendantGroup - Multi-Specialty