1801035563 NPI number — CARIBBEAN LIFE SUPPORT TRANSPORT CORP

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 1801035563 NPI number — CARIBBEAN LIFE SUPPORT TRANSPORT CORP

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
CARIBBEAN LIFE SUPPORT TRANSPORT CORP
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:
1801035563
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
02/19/2009
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
URB VISTA VERDE 714 CALLE 16
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
AGUADILLA
Provider Business Mailing Address State Name:
PR
Provider Business Mailing Address Postal Code:
00603
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
787-903-1658
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
CARRETERA 110 KM 21.1
Provider Second Line Business Practice Location Address:
BO. CEIBA BAJA
Provider Business Practice Location Address City Name:
MOCA
Provider Business Practice Location Address State Name:
PR
Provider Business Practice Location Address Postal Code:
00676
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
787-903-1658
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
02/19/2009

Additional Information

Authorized Official

Authorized Official Last Name:
MORALES
Authorized Official First Name:
KERMITT
Authorized Official Middle Name:
S
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
787-903-1658

Provider Taxonomy Codes

  • Taxonomy code: 3416L0300X , with the licence number:  TC AMB 560 , 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)





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