Provider Demographics
NPI:1982011631
Name:LUNA VISTA HOME HEALTHCARE LLC
Entity Type:Organization
Organization Name:LUNA VISTA HOME HEALTHCARE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR / OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JAMIE
Authorized Official - Middle Name:
Authorized Official - Last Name:GONZALES
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:505-977-3131
Mailing Address - Street 1:2116 VISTA OESTE NW
Mailing Address - Street 2:#1A
Mailing Address - City:ALBUQUERQUE
Mailing Address - State:NM
Mailing Address - Zip Code:87120-4340
Mailing Address - Country:US
Mailing Address - Phone:505-440-8316
Mailing Address - Fax:505-288-3494
Practice Address - Street 1:2116 VISTA OESTE NW
Practice Address - Street 2:#1A
Practice Address - City:ALBUQUERQUE
Practice Address - State:NM
Practice Address - Zip Code:87120-4340
Practice Address - Country:US
Practice Address - Phone:505-440-8316
Practice Address - Fax:505-288-3494
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-07-15
Last Update Date:2021-08-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health