Healthcare Provider Details

I. General information

NPI: 1558525600
Provider Name (Legal Business Name): HOGAR LUCERO DEL ALBA, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/17/2008
Last Update Date: 07/17/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

CARR. 816 INTERIOR 879 SECTOR CASILLAS RIVERA BARRIO NUEVO
BAYAMON PR
00956
US

IV. Provider business mailing address

8 CALLE CONDE URB. ESTACIAS DE LA FUENTE
TOA ALTA PR
00953-3603
US

V. Phone/Fax

Practice location:
  • Phone: 787-799-5305
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code311ZA0620X
TaxonomyAdult Care Home Facility
License Number263
License Number StatePR

VIII. Authorized Official

Name: MRS. IRMA LOPEZ
Title or Position: ADMINISTRADORA
Credential:
Phone: 787-214-1114