Provider Demographics
NPI:1134841745
Name:A HOME FOR LORENZO
Entity type:Organization
Organization Name:A HOME FOR LORENZO
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:MICHELLE
Authorized Official - Middle Name:
Authorized Official - Last Name:CAMPOS
Authorized Official - Suffix:
Authorized Official - Credentials:CEO, NCC, MS MHC
Authorized Official - Phone:915-305-6965
Mailing Address - Street 1:8213 VALLE ALEGRE DR
Mailing Address - Street 2:
Mailing Address - City:EL PASO
Mailing Address - State:TX
Mailing Address - Zip Code:79907-4244
Mailing Address - Country:US
Mailing Address - Phone:915-305-6965
Mailing Address - Fax:
Practice Address - Street 1:960 CHELSEA ST
Practice Address - Street 2:
Practice Address - City:EL PASO
Practice Address - State:TX
Practice Address - Zip Code:79903-4927
Practice Address - Country:US
Practice Address - Phone:915-213-4705
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-09-12
Last Update Date:2022-09-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA0600XAmbulatory Health Care FacilitiesClinic/CenterAdult Day Care