Provider Demographics
NPI:1689724882
Name:IV HOME THERAPY CORP
Entity Type:Organization
Organization Name:IV HOME THERAPY CORP
Other - Org Name:IV HOME THERAPY CORP
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:E
Authorized Official - Last Name:JOHNSON RODRIGUEZ
Authorized Official - Suffix:SR
Authorized Official - Credentials:LPN
Authorized Official - Phone:787-507-0371
Mailing Address - Street 1:LOS MAESTROS
Mailing Address - Street 2:CALLE MARTIN CORCHADO #8234
Mailing Address - City:PONCE
Mailing Address - State:PR
Mailing Address - Zip Code:00717-0254
Mailing Address - Country:US
Mailing Address - Phone:787-507-0371
Mailing Address - Fax:
Practice Address - Street 1:CARR VIEJA HACIA GUAYANILLA
Practice Address - Street 2:BDA BALDORITY #579
Practice Address - City:PONCE
Practice Address - State:PR
Practice Address - Zip Code:00717-1789
Practice Address - Country:US
Practice Address - Phone:787-507-0371
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-11
Last Update Date:2014-02-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR51251E00000X, 251J00000X
PR06-059251F00000X
PR1689724882261QM1300X
PR5275690001332BP3500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251J00000XAgenciesNursing Care
No251E00000XAgenciesHome Health
No251F00000XAgenciesHome Infusion
No261QM1300XAmbulatory Health Care FacilitiesClinic/CenterMulti-Specialty
No332BP3500XSuppliersDurable Medical Equipment & Medical SuppliesParenteral & Enteral Nutrition
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR54470OtherHALTHCARE OF P,R, REFORMA
PR19319OtherTRIPLE S
PR=========OtherOPTION HEALTH CARE NETWOR
PR54470OtherHALTHCARE OF P,R, REFORMA
PR0085472Medicare PIN