1558096875 NPI number — PROGRAMA DE SERVICIOS DE SALUD EN EL HOGAR Y HOSPICIO SAN LUCAS, INC

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1558096875 NPI number — PROGRAMA DE SERVICIOS DE SALUD EN EL HOGAR Y HOSPICIO SAN LUCAS, INC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
PROGRAMA DE SERVICIOS DE SALUD EN EL HOGAR Y HOSPICIO SAN LUCAS, 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:
1558096875
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
10/18/2023
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 7064
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
PONCE
Provider Business Mailing Address State Name:
PR
Provider Business Mailing Address Postal Code:
00732-7064
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
787-799-6740
Provider Business Mailing Address Fax Number:
787-799-6705

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
CARR 167, KM 19.5 (AVE COMERIO)
Provider Second Line Business Practice Location Address:
2ND FLOOR, ROYAL CLUB CONVENTION CENTER
Provider Business Practice Location Address City Name:
BAYAMON
Provider Business Practice Location Address State Name:
PR
Provider Business Practice Location Address Postal Code:
00958-4118
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
787-799-6740
Provider Business Practice Location Address Fax Number:
787-799-6705
Provider Enumeration Date:
07/20/2022

Additional Information

Authorized Official

Authorized Official Last Name:
CASTILLO MEDICA
Authorized Official First Name:
ISUANET
Authorized Official Middle Name:
Authorized Official Title or Position:
DIRECTORA EJECUTIVA OPERACIONAL
Authorized Official Telephone Number:
787-843-4185

Provider Taxonomy Codes

  • Taxonomy code: 251E00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





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