- Enrollment id
- O20140820001904
- Enrollment state
- PR
- Provider type code
- 00-06
- Provider type text
- PART A PROVIDER - HOME HEALTH AGENCY
- Npi
- 1487068375
- Multiple npi flag
- N
- Ccn
- 407314
- Associate id
- 1557589363
- Organization name
- METRO PAVIA AT HOME, LLC
- Doing business as name
- METRO PAVIA @ HOME - MAYAGUEZ
- Incorporation date
- 2014-03-28
- Incorporation state
- PR
- Organization type structure
- LLC
- Proprietary nonprofit
- P
- Address line 1
- PLAZA MONSERRATE IV CARR 345 KM 2.1 INT CARR PR 2
- Address line 2
- KM 2.0 BO LAUADERO
- City
- HORMIGUEROS
- State
- PR
- Zip code
- 00660