Provider Demographics
NPI:1932955226
Name:METRO PAVIA AT HOME, LLC
Entity Type:Organization
Organization Name:METRO PAVIA AT HOME, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:LISANDRA
Authorized Official - Middle Name:
Authorized Official - Last Name:VELEZ
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:787-705-6982
Mailing Address - Street 1:P.O.
Mailing Address - Street 2:BOX 11938
Mailing Address - City:SAN JUAN
Mailing Address - State:PR
Mailing Address - Zip Code:00922-1938
Mailing Address - Country:US
Mailing Address - Phone:787-705-6982
Mailing Address - Fax:787-705-6794
Practice Address - Street 1:#60 CALLE BOLIVIA
Practice Address - Street 2:3TH FLOOR
Practice Address - City:SAN JUAN
Practice Address - State:PR
Practice Address - Zip Code:00917-1104
Practice Address - Country:US
Practice Address - Phone:787-705-6982
Practice Address - Fax:787-705-6794
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-04-26
Last Update Date:2024-05-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251F00000XAgenciesHome Infusion
No251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR037568800Medicaid