Provider Demographics
NPI:1528241312
Name:LA HOMA MEDICAL EQUIPMENT & SUPPLY
Entity type:Organization
Organization Name:LA HOMA MEDICAL EQUIPMENT & SUPPLY
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MISS
Authorized Official - First Name:BERTHA
Authorized Official - Middle Name:ALICIA
Authorized Official - Last Name:MORENO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:956-424-0177
Mailing Address - Street 1:810 E VETERANS BLVD
Mailing Address - Street 2:SUITE K
Mailing Address - City:MISSION
Mailing Address - State:TX
Mailing Address - Zip Code:78572-5018
Mailing Address - Country:US
Mailing Address - Phone:956-424-0177
Mailing Address - Fax:956-424-1904
Practice Address - Street 1:810 E VETERANS BLVD
Practice Address - Street 2:SUITE K
Practice Address - City:MISSION
Practice Address - State:TX
Practice Address - Zip Code:78572-5018
Practice Address - Country:US
Practice Address - Phone:956-424-0177
Practice Address - Fax:956-424-1904
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-12-14
Last Update Date:2011-06-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX0099179332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX189113702Medicaid
TX189113701Medicaid
TX189113702Medicaid