Provider Demographics
NPI:1053542738
Name:LUZ DIVINA HOME CARE AGENCY L.L.C
Entity type:Organization
Organization Name:LUZ DIVINA HOME CARE AGENCY L.L.C
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:ANGEL
Authorized Official - Middle Name:
Authorized Official - Last Name:PORTORREAL
Authorized Official - Suffix:
Authorized Official - Credentials:RN
Authorized Official - Phone:610-437-2220
Mailing Address - Street 1:236 N 15TH ST
Mailing Address - Street 2:
Mailing Address - City:ALLENTOWN
Mailing Address - State:PA
Mailing Address - Zip Code:18102-3673
Mailing Address - Country:US
Mailing Address - Phone:610-437-2220
Mailing Address - Fax:610-437-2276
Practice Address - Street 1:236 N 15TH ST
Practice Address - Street 2:
Practice Address - City:ALLENTOWN
Practice Address - State:PA
Practice Address - Zip Code:18102-3673
Practice Address - Country:US
Practice Address - Phone:610-437-2220
Practice Address - Fax:610-437-2276
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-07-29
Last Update Date:2009-07-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253Z00000XAgenciesIn Home Supportive Care