1932667086 NPI number — CARE ALTERNATIVES OF PUERTO RICO LLC

Table of content: (NPI 1932667086)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1932667086 NPI number — CARE ALTERNATIVES OF PUERTO RICO LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
CARE ALTERNATIVES OF PUERTO RICO LLC
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:
GRACE HOSPICE OF PUERTO RICO
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:
1932667086
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
11/05/2019
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
65 JACKSON DR STE 103
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
CRANFORD
Provider Business Mailing Address State Name:
NJ
Provider Business Mailing Address Postal Code:
07016-3516
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
908-931-9068
Provider Business Mailing Address Fax Number:
732-384-3058

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
500 AVE MUNOZ RIVERA CONDOMINIO EI CENTRO
Provider Second Line Business Practice Location Address:
CONDOMINIO EI CENTRO
Provider Business Practice Location Address City Name:
SAN JUAN
Provider Business Practice Location Address State Name:
PR
Provider Business Practice Location Address Postal Code:
00918
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
908-931-9068
Provider Business Practice Location Address Fax Number:
732-384-3058
Provider Enumeration Date:
03/07/2019

Additional Information

Authorized Official

Authorized Official Last Name:
EFODILI
Authorized Official First Name:
YEWANDE
Authorized Official Middle Name:
Authorized Official Title or Position:
DIRECTOR OF BILLING
Authorized Official Telephone Number:
908-931-9068

Provider Taxonomy Codes

  • Taxonomy code: 251G00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





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