1497749501 NPI number — ST LUKES EPISCOPAL CHURCH HOME CARE PROGRAM

Table of content: (NPI 1497749501)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1497749501 NPI number — ST LUKES EPISCOPAL CHURCH HOME CARE PROGRAM

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
ST LUKES EPISCOPAL CHURCH HOME CARE PROGRAM
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
ST. LUKES HOME HEALTH AGENCY UTUADO
Provider Other Organization Name Type Code:
3
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1497749501
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
07/24/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
APDO 1292
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
UTUADO
Provider Business Mailing Address State Name:
PR
Provider Business Mailing Address Postal Code:
00641
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
787-843-4185
Provider Business Mailing Address Fax Number:
787-843-5850

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
#79 CALLE DR CUETO
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
UTUADO
Provider Business Practice Location Address State Name:
PR
Provider Business Practice Location Address Postal Code:
00641
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
787-843-4185
Provider Business Practice Location Address Fax Number:
787-843-5850
Provider Enumeration Date:
09/02/2005

Additional Information

Authorized Official

Authorized Official Last Name:
HERNANDEZ
Authorized Official First Name:
MAYRA
Authorized Official Middle Name:
Authorized Official Title or Position:
GERENTE FACTURACION & COBRO
Authorized Official Telephone Number:
787-843-5855

Provider Taxonomy Codes

  • Taxonomy code: 251E00000X , with the licence number:  41 , registered in the state of PR ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 071002 . This is a "CRUZ AZUL" identifier , issued by the state of ( PR ) . This identifiers is of the category "OTHER".
  • Identifier: 1-9485ST . This is a "TRIPLE S" identifier , issued by the state of ( PR ) . This identifiers is of the category "OTHER".
  • Identifier: 7330102 . This is a "HUMANA" identifier , issued by the state of ( PR ) . This identifiers is of the category "OTHER".
  • Identifier: 9800093 . This is a "ACAA" identifier , issued by the state of ( PR ) . This identifiers is of the category "OTHER".




Copyright © 2007-2024 www.npivalidator.com