MEDICARE: ST LUKES EPISCOPAL CHURCH HOME CARE PROGRAM

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	251E00000X	Home Health Agency	25	PR

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	1-9485ST	OTHER	PR	TRIPLE S
2	9800093	OTHER	PR	ACAA
3	071002	OTHER	PR	CRUZ AZUL
4	7330102	OTHER	PR	HUMANA

General Provider Information

NPI Number	:	1508865312
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ST LUKES EPISCOPAL CHURCH HOME CARE PROGRAM

Provider Business Mailing Address
First Line	:	RR1 BOX 6091
Second Line	:
City	:	GUAYAMA
State	:	PR
Zip	:	00784-9601
Country	:	US
Telephone Number	:	787-843-4185
Fax Number	:	787-843-5850

Provider Business Practice Location Address
First Line	:	CENTRO COMERCIAL SAN VICENTE MALL
Second Line	:	SECTOR MELANIA CARR #3
City	:	GUAYAMA
State	:	PR
Zip	:	00784-9601
Country	:	US
Telephone Number	:	787-843-4185
Fax Number	:

Authorized Official
Title or Position	:	OPERATIONAL EXECUTIVE DIRECTOR
Name	:	MS. ISUANET CASTILLO
Credential	:	CPA
Telephone Number	:	787-843-4185

Provider Enumeration Date	:	07/14/2005
Last Update Date	:	12/20/2011

Similar Medicare Providers

1013909712 — ST LUKES EPISCOPAL CHURCH HOME CARE PROGRAM
Practice Location Address:

SECTOR MELANIA CARR. #3 , CENTRO COMERCIAL SAN VICENTE MALL
GUAYAMA, PR
00784-9601

Practice Phone: 787-843-4185
Practice Fax: 787-259-7135

1134806961 — JULIEANA MARIE VAZQUEZ ORTIZ
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1427665009 — CARLOS ARMANDO ALEJANDRO MD
Practice Location Address:

CALLE ASHFORD 84 SUR
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00784-0001

Practice Phone: 787-864-0025
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1518960624 — FARMACIA M&F
Practice Location Address:

CARR #3 KM 149.9 , BO PUENTE DE JOBOS
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00784

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Practice Fax: 787-864-8061

1184628836 — DR. LYSANDER BORRERO M.D.
Practice Location Address:

AVE. ASHFORT-URB. GIBRALTAR #1 OFICINA-3(BAJOS) , AVE. ASHFORT-URB. GIBRALTAR #1 OFICINA-3(BAJOS)
GUAYAMA, PR
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1659379303 — DR. LUIS ALBERTO DOMINGUEZ CARRAZQUILLO DDS
Practice Location Address:

CALLE PALMER SUR #24
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00784-7610

Practice Phone: 787-866-3631
Practice Fax: 787-866-8690

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