Provider Demographics
NPI:1871704718
Name:LA FUENTE, INC
Entity type:Organization
Organization Name:LA FUENTE, INC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:VERONICA
Authorized Official - Middle Name:
Authorized Official - Last Name:ALEMAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:956-485-2400
Mailing Address - Street 1:PO BOX 280
Mailing Address - Street 2:
Mailing Address - City:SULLIVAN CITY
Mailing Address - State:TX
Mailing Address - Zip Code:78595-0280
Mailing Address - Country:US
Mailing Address - Phone:956-485-2400
Mailing Address - Fax:956-485-1193
Practice Address - Street 1:801 W HIGHWAY 83
Practice Address - Street 2:
Practice Address - City:SULLIVAN CITY
Practice Address - State:TX
Practice Address - Zip Code:78595
Practice Address - Country:US
Practice Address - Phone:956-485-2400
Practice Address - Fax:956-485-1193
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-24
Last Update Date:2021-07-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253Z00000XAgenciesIn Home Supportive Care
No251E00000XAgenciesHome Health
No251J00000XAgenciesNursing Care
No261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care
No385H00000XRespite Care FacilityRespite Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX001004180Medicaid
TX001004180Medicaid