1811527633 NPI number — LA HACIENDA HOMECARE, LLC,

Table of content: MRS. TESSA LEANN PRICE SLP (NPI 1518772557)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1811527633 NPI number — LA HACIENDA HOMECARE, LLC,

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
LA HACIENDA HOMECARE, 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:
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:
1811527633
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
04/20/2021
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
246 EBANO CIRCLE
Provider Second Line Business Mailing Address:
STE B
Provider Business Mailing Address City Name:
LA JOYA
Provider Business Mailing Address State Name:
TX
Provider Business Mailing Address Postal Code:
78560
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
956-424-0124
Provider Business Mailing Address Fax Number:
956-424-0292

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
246 EBANO CIRCLE
Provider Second Line Business Practice Location Address:
STE B
Provider Business Practice Location Address City Name:
LA JOYA
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
78560
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
956-424-0124
Provider Business Practice Location Address Fax Number:
956-424-0292
Provider Enumeration Date:
01/21/2020

Additional Information

Authorized Official

Authorized Official Last Name:
BERITEZ
Authorized Official First Name:
RICARDO
Authorized Official Middle Name:
Authorized Official Title or Position:
ADMINISTRATOR/CEO
Authorized Official Telephone Number:
956-424-0124

Provider Taxonomy Codes

  • Taxonomy code: 3747P1801X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





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