1629062815 NPI number — ST LUKES EPISCOPAL CHURCH HOME CARE PROGRAM

Table of content: (NPI 1629062815)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1629062815 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:
Provider Other Organization Name Type Code:
6
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:
1629062815
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
12/16/2011
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
APDO 8156
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
CAGUAS
Provider Business Mailing Address State Name:
PR
Provider Business Mailing Address Postal Code:
00726
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:
CALLE E URB INDUSTRIAL VILLA BLANCA
Provider Second Line Business Practice Location Address:
EDIFICIO ANGORA
Provider Business Practice Location Address City Name:
CAGUAS
Provider Business Practice Location Address State Name:
PR
Provider Business Practice Location Address Postal Code:
00726
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:
CASTILLO
Authorized Official First Name:
ISUANET
Authorized Official Middle Name:
Authorized Official Title or Position:
OPERATIONAL EXECUTIVE DIRECTOR
Authorized Official Telephone Number:
787-843-4185

Provider Taxonomy Codes

  • Taxonomy code: 251E00000X , with the licence number:  33 , 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: 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".
  • Identifier: 071002 . This is a "CRUZ AZUL" identifier , issued by the state of ( PR ) . This identifiers is of the category "OTHER".




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