Provider Demographics
NPI:1730191560
Name:BUENA SUERTE HOME HEALTH, LTD.
Entity type:Organization
Organization Name:BUENA SUERTE HOME HEALTH, LTD.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MR
Authorized Official - First Name:MARTIN
Authorized Official - Middle Name:
Authorized Official - Last Name:PENA II
Authorized Official - Suffix:II
Authorized Official - Credentials:
Authorized Official - Phone:956-702-9933
Mailing Address - Street 1:1307 W. FERGUSON
Mailing Address - Street 2:
Mailing Address - City:PHARR
Mailing Address - State:TX
Mailing Address - Zip Code:78577-2107
Mailing Address - Country:US
Mailing Address - Phone:956-702-9933
Mailing Address - Fax:956-702-9966
Practice Address - Street 1:1307 W. FERGUSON
Practice Address - Street 2:
Practice Address - City:PHARR
Practice Address - State:TX
Practice Address - Zip Code:78577-2107
Practice Address - Country:US
Practice Address - Phone:956-702-9933
Practice Address - Fax:956-702-9966
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-12
Last Update Date:2009-09-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX009880251E00000X
TX012635251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX009880Medicaid
TX679514Medicare ID - Type UnspecifiedMEDICARE PROVIDER NUMBER
TX009880Medicaid