Provider Demographics
NPI:1912387788
Name:MANNA PROVIDER SERVICES, LLC.
Entity Type:Organization
Organization Name:MANNA PROVIDER SERVICES, LLC.
Other - Org Name:MANNA PROVIDER SERVICES, LLC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:HERMELINDA
Authorized Official - Middle Name:MONICA
Authorized Official - Last Name:JIMENEZ
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:956-754-3975
Mailing Address - Street 1:1915 WOODLAND DR
Mailing Address - Street 2:
Mailing Address - City:LAREDO
Mailing Address - State:TX
Mailing Address - Zip Code:78045-8353
Mailing Address - Country:US
Mailing Address - Phone:956-754-3975
Mailing Address - Fax:
Practice Address - Street 1:1915 WOODLAND DR
Practice Address - Street 2:1915 WOODLAND DR.
Practice Address - City:LAREDO
Practice Address - State:TX
Practice Address - Zip Code:78045-8353
Practice Address - Country:US
Practice Address - Phone:956-754-3975
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-06-05
Last Update Date:2024-03-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes3747P1801XNursing Service Related ProvidersTechnicianPersonal Care AttendantGroup - Multi-Specialty
No251C00000XAgenciesDay Training, Developmentally Disabled ServicesGroup - Multi-Specialty
No253Z00000XAgenciesIn Home Supportive CareGroup - Multi-Specialty