1053401372 NPI number — PUEBLO DE SALUD HOME HEALTH SERVICES LLC

Table of content: MRS. CATHERINE ZUCK MILLER MPH, RD, LD, CDE (NPI 1659435469)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1053401372 NPI number — PUEBLO DE SALUD HOME HEALTH SERVICES LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
PUEBLO DE SALUD HOME HEALTH SERVICES LLC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
ADVANCED HEALTHCARE
Provider Other Organization Name Type Code:
3
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1053401372
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
03/14/2017
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 26704
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
EL PASO
Provider Business Mailing Address State Name:
TX
Provider Business Mailing Address Postal Code:
79926-6704
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
915-590-3330
Provider Business Mailing Address Fax Number:
915-594-8245

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
3431 PERSHING DR
Provider Second Line Business Practice Location Address:
STE A4
Provider Business Practice Location Address City Name:
EL PASO
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
79903-2754
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
915-590-3330
Provider Business Practice Location Address Fax Number:
915-594-8245
Provider Enumeration Date:
10/15/2006

Additional Information

Authorized Official

Authorized Official Last Name:
GAONA
Authorized Official First Name:
MAYRA
Authorized Official Middle Name:
E
Authorized Official Title or Position:
ADMINISTRATOR
Authorized Official Telephone Number:
915-590-3330

Provider Taxonomy Codes

  • Taxonomy code: 251E00000X , registered in the state of TX ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 2051179 , issued by the state of ( TX ) . This identifiers is of the category "MEDICAID".




Copyright © 2007-2024 www.npivalidator.com