Provider Demographics
NPI:1679722490
Name:MONTERO HOME CARE SERVICES, LLC
Entity Type:Organization
Organization Name:MONTERO HOME CARE SERVICES, LLC
Other - Org Name:MONTERO HOME CARE SERVICES
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CFO
Authorized Official - Prefix:MR
Authorized Official - First Name:DENNIS
Authorized Official - Middle Name:PAUL
Authorized Official - Last Name:ACKERMAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:757-621-1630
Mailing Address - Street 1:5441 VA BEACH BLVD
Mailing Address - Street 2:SUITE #107
Mailing Address - City:VIRGINIA BEACH
Mailing Address - State:VA
Mailing Address - Zip Code:23462-1749
Mailing Address - Country:US
Mailing Address - Phone:757-490-0124
Mailing Address - Fax:757-490-0125
Practice Address - Street 1:5441 VA BEACH BLVD
Practice Address - Street 2:SUITE #107
Practice Address - City:VIRGINIA BEACH
Practice Address - State:VA
Practice Address - Zip Code:23462-1749
Practice Address - Country:US
Practice Address - Phone:757-490-0124
Practice Address - Fax:757-490-0125
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:MONTERO HOME CARE SERVICES
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2008-09-17
Last Update Date:2008-09-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VAMONTERO251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health