Provider Demographics
NPI:1871352740
Name:LOS OLIVOS HOME CARE LLC
Entity type:Organization
Organization Name:LOS OLIVOS HOME CARE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:YURITZI
Authorized Official - Middle Name:NA
Authorized Official - Last Name:PENA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:956-371-2453
Mailing Address - Street 1:6334 MONTE BONITO
Mailing Address - Street 2:
Mailing Address - City:BROWNSVILLE
Mailing Address - State:TX
Mailing Address - Zip Code:78521-6202
Mailing Address - Country:US
Mailing Address - Phone:956-371-2453
Mailing Address - Fax:
Practice Address - Street 1:6334 MONTE BONITO
Practice Address - Street 2:
Practice Address - City:BROWNSVILLE
Practice Address - State:TX
Practice Address - Zip Code:78521-6202
Practice Address - Country:US
Practice Address - Phone:956-371-2453
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-03-14
Last Update Date:2024-05-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes253Z00000XAgenciesIn Home Supportive CareGroup - Multi-Specialty
No3747P1801XNursing Service Related ProvidersTechnicianPersonal Care AttendantGroup - Multi-Specialty