Healthcare Provider Details

I. General information

NPI: 1619363470
Provider Name (Legal Business Name): SACRED HEART NURSES, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/08/2015
Last Update Date: 11/14/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

KULOT STREET, CHALAN KIYA
SAIPAN MP
96950-4305
US

IV. Provider business mailing address

PO BOX 504576
SAIPAN MP
96950-4305
US

V. Phone/Fax

Practice location:
  • Phone: 670-285-1805
  • Fax:
Mailing address:
  • Phone: 670-285-1805
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License Number
License Number State

VIII. Authorized Official

Name: MRS. LETICIA DEDUMO REYES
Title or Position: SECRETARY/TREASURER
Credential: FNP
Phone: 670-285-1805