1174817076 NPI number — LAREDO VISITING NURSES, INC.

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1174817076 NPI number — LAREDO VISITING NURSES, INC.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
LAREDO VISITING NURSES, INC.
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:
DEL CIELO HOME HEALTH & HOSPICE
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:
1174817076
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
04/13/2021
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
422 S ENTERPRIZE PKWY
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
CORPUS CHRISTI
Provider Business Mailing Address State Name:
TX
Provider Business Mailing Address Postal Code:
78405-3913
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
361-814-4500
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
411 N KING ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
ALICE
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
78332-4763
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
361-664-3484
Provider Business Practice Location Address Fax Number:
361-723-0212
Provider Enumeration Date:
06/08/2011

Additional Information

Authorized Official

Authorized Official Last Name:
ELIZONDO
Authorized Official First Name:
ANDRES
Authorized Official Middle Name:
Authorized Official Title or Position:
CHIEF EXECUTIVE OFFICER
Authorized Official Telephone Number:
361-814-4500

Provider Taxonomy Codes

  • Taxonomy code: 251G00000X , with the licence number:  0010700 , 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: 001019165 , issued by the state of ( TX ) . This identifiers is of the category "MEDICAID".




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