Provider Demographics
NPI:1144685710
Name:CANVI GROUP, LLC
Entity type:Organization
Organization Name:CANVI GROUP, LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:JULIO
Authorized Official - Middle Name:
Authorized Official - Last Name:CANTU
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:956-223-4528
Mailing Address - Street 1:208 WEST FERGUSON UNIT 4 SUITE 5
Mailing Address - Street 2:
Mailing Address - City:PHARR
Mailing Address - State:TX
Mailing Address - Zip Code:78577-2455
Mailing Address - Country:US
Mailing Address - Phone:956-223-4528
Mailing Address - Fax:956-461-0065
Practice Address - Street 1:208 WEST FERGUSON UNIT 4 SUITE 5
Practice Address - Street 2:
Practice Address - City:PHARR
Practice Address - State:TX
Practice Address - Zip Code:78577-2455
Practice Address - Country:US
Practice Address - Phone:956-223-4528
Practice Address - Fax:956-461-0065
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-12-23
Last Update Date:2015-12-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health