MEDICARE: HOGAR LLEVANDO LUZ A LAS TINIEBLAS

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	324500000X	Substance Abuse Rehabilitation Facility		PR

General Provider Information

NPI Number	:	1124312251
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	HOGAR LLEVANDO LUZ A LAS TINIEBLAS

Provider Business Mailing Address
First Line	:	CALLE VIA PELICANO CK9505 CAMINOS DEL MAR
Second Line	:
City	:	TOA BAJA
State	:	PUERTO RICO
Zip	:	00949
Country	:	UM
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	1007 AVE DOS PALMAS
Second Line	:
City	:	TOA BAJA
State	:	PR
Zip	:	00949-4101
Country	:	US
Telephone Number	:	787-378-4221
Fax Number	:

Authorized Official
Title or Position	:	PRESIDENT
Name	:	ARMANDO RIJOS
Credential	:
Telephone Number	:	787-378-4221

Provider Enumeration Date	:	06/07/2011
Last Update Date	:	06/07/2011

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