Healthcare Provider Details

I. General information

NPI: 1558096875
Provider Name (Legal Business Name): PROGRAMA DE SERVICIOS DE SALUD EN EL HOGAR Y HOSPICIO SAN LUCAS, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/20/2022
Last Update Date: 10/18/2023
Certification Date: 12/23/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

CARR 167, KM 19.5 (AVE COMERIO) 2ND FLOOR, ROYAL CLUB CONVENTION CENTER
BAYAMON PR
00958-4118
US

IV. Provider business mailing address

PO BOX 7064
PONCE PR
00732-7064
US

V. Phone/Fax

Practice location:
  • Phone: 787-799-6740
  • Fax: 787-799-6705
Mailing address:
  • Phone: 787-799-6740
  • Fax: 787-799-6705

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name: MRS. ISUANET CASTILLO MEDICA
Title or Position: DIRECTORA EJECUTIVA OPERACIONAL
Credential: CPA
Phone: 787-843-4185