Provider Demographics
NPI:1487700308
Name:LA LUZ HEALTH CARE SERVICES, INC
Entity type:Organization
Organization Name:LA LUZ HEALTH CARE SERVICES, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:NORA
Authorized Official - Middle Name:E
Authorized Official - Last Name:OLIVARES
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:956-421-3400
Mailing Address - Street 1:1702 E TYLER AVE
Mailing Address - Street 2:SUITE 4
Mailing Address - City:HARLINGEN
Mailing Address - State:TX
Mailing Address - Zip Code:78550-7115
Mailing Address - Country:US
Mailing Address - Phone:956-421-3400
Mailing Address - Fax:956-421-3454
Practice Address - Street 1:1702 E TYLER AVE
Practice Address - Street 2:SUITE 4
Practice Address - City:HARLINGEN
Practice Address - State:TX
Practice Address - Zip Code:78550-7115
Practice Address - Country:US
Practice Address - Phone:956-421-3400
Practice Address - Fax:956-421-3454
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-25
Last Update Date:2014-12-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX016192251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX016192OtherLICENSE
TX677895OtherP10#
TX677895Medicare ID - Type UnspecifiedHOME HEALTH