MEDICARE: CONDADO HOME CARE, INC.

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	407011	PR

General Provider Information

NPI Number	:	1962588285
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	CONDADO HOME CARE, INC.

Provider Business Mailing Address
First Line	:	409 CALLE BEGONIA
Second Line	:	QUINTAS DE CAMPECHE
City	:	CAROLINA
State	:	PR
Zip	:	00987-7159
Country	:	US
Telephone Number	:	787-607-3943
Fax Number	:	787-276-5457

Provider Business Practice Location Address
First Line	:	186 CALLE JUAN P DUARTE
Second Line	:	HATO REY
City	:	SAN JUAN
State	:	PR
Zip	:	00917-3602
Country	:	US
Telephone Number	:	787-758-8180
Fax Number	:	787-274-1571

Authorized Official
Title or Position	:	EXECUTIVE DIRECTOR
Name	:	MRS. CARMEN LYDIA TORRES
Credential	:	MASTERS IN ECONOMY
Telephone Number	:	787-758-8180

Provider Enumeration Date	:	10/29/2006
Last Update Date	:	06/03/2008

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