Provider Demographics
NPI:1932627544
Name:MORENA DIVINA HOME CARE LLC
Entity Type:Organization
Organization Name:MORENA DIVINA HOME CARE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:MIRNA
Authorized Official - Middle Name:
Authorized Official - Last Name:LUGO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:956-225-9062
Mailing Address - Street 1:2525 VINE AVE
Mailing Address - Street 2:
Mailing Address - City:MCALLEN
Mailing Address - State:TX
Mailing Address - Zip Code:78501
Mailing Address - Country:US
Mailing Address - Phone:956-821-2556
Mailing Address - Fax:
Practice Address - Street 1:2525 VINE AVE
Practice Address - Street 2:
Practice Address - City:MCALLEN
Practice Address - State:TX
Practice Address - Zip Code:78501
Practice Address - Country:US
Practice Address - Phone:956-821-2556
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-09-03
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health