Healthcare Provider Details

I. General information

NPI: 1629002316
Provider Name (Legal Business Name): SERVICIOS DE SALUD EN EL HOGAR EL GIGANTE, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/10/2006
Last Update Date: 02/09/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

66 CALLE RODULFO GONZALEZ APARTADO 117
ADJUNTAS PR
00601-2150
US

IV. Provider business mailing address

580 AVE DE DIEGO PUERTO NUEVO
SAN JUAN PR
00920-3723
US

V. Phone/Fax

Practice location:
  • Phone: 787-829-7710
  • Fax: 787-829-4453
Mailing address:
  • Phone: 787-620-5577
  • Fax: 787-620-5582

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License Number17810
License Number StatePR

VIII. Authorized Official

Name: CARMEN SANTIAGO
Title or Position: CEO
Credential: DRPH
Phone: 817-310-1100