Provider Demographics
NPI:1811527633
Name:LA HACIENDA HOMECARE, LLC,
Entity type:Organization
Organization Name:LA HACIENDA HOMECARE, LLC,
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR/CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:RICARDO
Authorized Official - Middle Name:
Authorized Official - Last Name:BERITEZ
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:956-424-0124
Mailing Address - Street 1:246 EBANO CIRCLE
Mailing Address - Street 2:STE B
Mailing Address - City:LA JOYA
Mailing Address - State:TX
Mailing Address - Zip Code:78560
Mailing Address - Country:US
Mailing Address - Phone:956-424-0124
Mailing Address - Fax:956-424-0292
Practice Address - Street 1:246 EBANO CIRCLE
Practice Address - Street 2:STE B
Practice Address - City:LA JOYA
Practice Address - State:TX
Practice Address - Zip Code:78560
Practice Address - Country:US
Practice Address - Phone:956-424-0124
Practice Address - Fax:956-424-0292
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-01-21
Last Update Date:2021-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes3747P1801XNursing Service Related ProvidersTechnicianPersonal Care AttendantGroup - Single Specialty