Provider Demographics
NPI:1841604733
Name:METRO PAVIA AT HOME LLC
Entity Type:Organization
Organization Name:METRO PAVIA AT HOME LLC
Other - Org Name:METRO PAVIA @ HOME-PONCE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:ADMINISTRADORA
Authorized Official - Prefix:
Authorized Official - First Name:SOFIA
Authorized Official - Middle Name:
Authorized Official - Last Name:PEREZ
Authorized Official - Suffix:I
Authorized Official - Credentials:
Authorized Official - Phone:787-842-0554
Mailing Address - Street 1:PO BOX 11938
Mailing Address - Street 2:
Mailing Address - City:SAN JUAN
Mailing Address - State:PR
Mailing Address - Zip Code:00922-1938
Mailing Address - Country:US
Mailing Address - Phone:787-999-8942
Mailing Address - Fax:
Practice Address - Street 1:MICHELLE PLAZA 1212 CALLE ACACIA OFIC 215
Practice Address - Street 2:
Practice Address - City:PONCE
Practice Address - State:PR
Practice Address - Zip Code:00716
Practice Address - Country:US
Practice Address - Phone:787-842-0554
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-06-18
Last Update Date:2014-09-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health