1508876335 NPI number — HUELLITAS DE AMOR PEDIATRIC HOME CARE,INC.

Table of content: (NPI 1508876335)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1508876335 NPI number — HUELLITAS DE AMOR PEDIATRIC HOME CARE,INC.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
HUELLITAS DE AMOR PEDIATRIC HOME CARE,INC.
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:
Provider Other Organization Name Type Code:
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:
1508876335
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
07/14/2015
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
200 AVE. RAFAEL CORDERO SUITE # 140
Provider Second Line Business Mailing Address:
PMB 465
Provider Business Mailing Address City Name:
CAGUAS
Provider Business Mailing Address State Name:
PR
Provider Business Mailing Address Postal Code:
00725
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
787-633-5163
Provider Business Mailing Address Fax Number:
787-746-4444

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
EXT CAGUAX CARR 189
Provider Second Line Business Practice Location Address:
EDIFICIO INGEPROM
Provider Business Practice Location Address City Name:
CAGUAS
Provider Business Practice Location Address State Name:
PR
Provider Business Practice Location Address Postal Code:
00725
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
787-633-5163
Provider Business Practice Location Address Fax Number:
787-746-4444
Provider Enumeration Date:
08/08/2006

Additional Information

Authorized Official

Authorized Official Last Name:
LOPEZ
Authorized Official First Name:
LINNETTE
Authorized Official Middle Name:
M
Authorized Official Title or Position:
ADMINISTRATOR
Authorized Official Telephone Number:
787-633-5163

Provider Taxonomy Codes

  • Taxonomy code: 163WH0200X , with the licence number:  # 48 , 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: 100987 . This is a "LA CRUZ AZUL DE PR, INC." identifier , issued by the state of ( PR ) . This identifiers is of the category "OTHER".
  • Identifier: 48 . This is a "PEDIATRIC HOME HEALTH AGENCY" identifier , issued by the state of ( PR ) . This identifiers is of the category "OTHER".
  • Identifier: 57845 . This is a "TRIPLE - S,INC" identifier , issued by the state of ( PR ) . This identifiers is of the category "OTHER".
  • Identifier: 7780029 . This is a "HUMANA HEALTH PLANS OF PR" identifier , issued by the state of ( PR ) . This identifiers is of the category "OTHER".




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