1487068375 NPI number — METRO PAVIA AT HOME LLC

Table of content: (NPI 1487068375)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1487068375 NPI number — METRO PAVIA AT HOME LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
METRO PAVIA AT HOME 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:
Provider Other Organization Name Type Code:
6
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:
1487068375
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
04/29/2024
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 11938
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
SAN JUAN
Provider Business Mailing Address State Name:
PR
Provider Business Mailing Address Postal Code:
00922-1938
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
787-705-6982
Provider Business Mailing Address Fax Number:
787-705-6794

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
PLAZA MONSERRATE IV
Provider Second Line Business Practice Location Address:
CARR 345 KM 2.1 INTERSECCION CARR PR 2 KM 2.0 BARRIO LA
Provider Business Practice Location Address City Name:
SAN JUAN
Provider Business Practice Location Address State Name:
PR
Provider Business Practice Location Address Postal Code:
00660-8606
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
787-833-1985
Provider Business Practice Location Address Fax Number:
787-705-6794
Provider Enumeration Date:
06/18/2014

Additional Information

Authorized Official

Authorized Official Last Name:
VELEZ
Authorized Official First Name:
LISANDRA
Authorized Official Middle Name:
Authorized Official Title or Position:
EXECUTIVE DIRECTOR
Authorized Official Telephone Number:
787-705-6982

Provider Taxonomy Codes

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

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

  • Identifier: 037552400 , issued by the state of ( PR ) . This identifiers is of the category "MEDICAID".




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