Provider Demographics
NPI:1003658774
Name:MONTE CRISTO HOME HEALTH LLC
Entity type:Organization
Organization Name:MONTE CRISTO HOME HEALTH LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:DANIEL
Authorized Official - Middle Name:
Authorized Official - Last Name:BUSTILLOS
Authorized Official - Suffix:
Authorized Official - Credentials:DNP
Authorized Official - Phone:915-244-4966
Mailing Address - Street 1:5805 MCNUTT RD STE D
Mailing Address - Street 2:
Mailing Address - City:SANTA TERESA
Mailing Address - State:NM
Mailing Address - Zip Code:88008-8001
Mailing Address - Country:US
Mailing Address - Phone:575-332-4007
Mailing Address - Fax:575-332-4453
Practice Address - Street 1:5805 MCNUTT RD STE D
Practice Address - Street 2:
Practice Address - City:SANTA TERESA
Practice Address - State:NM
Practice Address - Zip Code:88008-8001
Practice Address - Country:US
Practice Address - Phone:575-332-4007
Practice Address - Fax:575-332-4453
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-06-12
Last Update Date:2024-09-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health