Provider Demographics
NPI:1972917946
Name:METRO PAVIA AT HOME LLC
Entity type:Organization
Organization Name:METRO PAVIA AT HOME LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:LISANDRA
Authorized Official - Middle Name:
Authorized Official - Last Name:VELEZ
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:787-705-6982
Mailing Address - Street 1:PO BOX 11938
Mailing Address - Street 2:
Mailing Address - City:SAN JUAN
Mailing Address - State:PR
Mailing Address - Zip Code:00922-1938
Mailing Address - Country:US
Mailing Address - Phone:787-705-6982
Mailing Address - Fax:787-705-6794
Practice Address - Street 1:60 CALLE BOLIVIA
Practice Address - Street 2:3RD FLOOR
Practice Address - City:SAN JUAN
Practice Address - State:PR
Practice Address - Zip Code:00917-1104
Practice Address - Country:US
Practice Address - Phone:787-705-6982
Practice Address - Fax:787-705-6794
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-06-17
Last Update Date:2024-04-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR037568800Medicaid