Provider Demographics
NPI:1659126316
Name:TRES ENCANTOS LLC
Entity Type:Organization
Organization Name:TRES ENCANTOS LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:LUIS
Authorized Official - Middle Name:
Authorized Official - Last Name:PERALTA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:310-469-2921
Mailing Address - Street 1:3044 INDUSTRY ST STE 104
Mailing Address - Street 2:
Mailing Address - City:OCEANSIDE
Mailing Address - State:CA
Mailing Address - Zip Code:92054-4857
Mailing Address - Country:US
Mailing Address - Phone:760-636-8903
Mailing Address - Fax:
Practice Address - Street 1:3044 INDUSTRY ST STE 104
Practice Address - Street 2:
Practice Address - City:OCEANSIDE
Practice Address - State:CA
Practice Address - Zip Code:92054-4857
Practice Address - Country:US
Practice Address - Phone:760-636-8903
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-04-17
Last Update Date:2024-04-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health