Provider Demographics
NPI:1669477527
Name:LOS EBANOS HOME HEALTH CARE, INC
Entity Type:Organization
Organization Name:LOS EBANOS HOME HEALTH CARE, INC
Other - Org Name:LOS EBANOS MEDICAL EQUIPMENT
Other - Org Type:Other Name
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:J
Authorized Official - Last Name:DE LACHICA
Authorized Official - Suffix:
Authorized Official - Credentials:RPH
Authorized Official - Phone:956-544-1974
Mailing Address - Street 1:1134 E LOS EBANOS BLVD
Mailing Address - Street 2:
Mailing Address - City:BROWNSVILLE
Mailing Address - State:TX
Mailing Address - Zip Code:78520-8730
Mailing Address - Country:US
Mailing Address - Phone:956-544-1976
Mailing Address - Fax:956-986-6108
Practice Address - Street 1:1134 E LOS EBANOS BLVD
Practice Address - Street 2:
Practice Address - City:BROWNSVILLE
Practice Address - State:TX
Practice Address - Zip Code:78520-8730
Practice Address - Country:US
Practice Address - Phone:956-544-1976
Practice Address - Fax:956-986-6108
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-06-16
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX0041087332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX0369290001Medicare NSC