Healthcare Provider Details

I. General information

NPI: 1013901123
Provider Name (Legal Business Name): ST LUKES EPISCOPAL CHURCH HOME CARE PROGRAM
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/02/2005
Last Update Date: 07/24/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

CARR #2 KM 124.9 BO CIMITAL BAJO
AGUADILLA PR
00605
US

IV. Provider business mailing address

APARTADO 1809 VICTORIA STATION
AGUADILLA PR
00605
US

V. Phone/Fax

Practice location:
  • Phone: 787-843-4185
  • Fax: 787-843-5850
Mailing address:
  • Phone: 787-843-4185
  • Fax: 787-843-5850

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License Number42
License Number StatePR

VIII. Authorized Official

Name: MRS. MAYRA HERNANDEZ
Title or Position: GERENTE FACHTURANCION Y COBRO
Credential:
Phone: 787-843-5855