Provider Demographics
NPI:1144865809
Name:MEDELLA HEALTHCARE, INC.
Entity type:Organization
Organization Name:MEDELLA HEALTHCARE, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:ERIKA
Authorized Official - Middle Name:
Authorized Official - Last Name:TAVAREZ
Authorized Official - Suffix:
Authorized Official - Credentials:CMF
Authorized Official - Phone:915-540-5195
Mailing Address - Street 1:702 E YANDELL DR
Mailing Address - Street 2:
Mailing Address - City:EL PASO
Mailing Address - State:TX
Mailing Address - Zip Code:79902-5314
Mailing Address - Country:US
Mailing Address - Phone:915-955-2525
Mailing Address - Fax:915-201-1318
Practice Address - Street 1:702 E YANDELL DR
Practice Address - Street 2:
Practice Address - City:EL PASO
Practice Address - State:TX
Practice Address - Zip Code:79902-5314
Practice Address - Country:US
Practice Address - Phone:915-955-2525
Practice Address - Fax:915-201-1318
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-11-16
Last Update Date:2023-01-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes261QR0405XAmbulatory Health Care FacilitiesClinic/CenterRehabilitation, Substance Use Disorder
No175T00000XOther Service ProvidersPeer SpecialistGroup - Multi-Specialty
No246RM2200XTechnologists, Technicians & Other Technical Service ProvidersTechnician, PathologyMedical LaboratoryGroup - Multi-Specialty
No251E00000XAgenciesHome HealthGroup - Multi-Specialty
No251F00000XAgenciesHome Infusion
No251S00000XAgenciesCommunity/Behavioral Health
No253Z00000XAgenciesIn Home Supportive CareGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX32072474136OtherCOMPTROLLER