Healthcare Provider Details

I. General information

NPI: 1295837524
Provider Name (Legal Business Name): ESTANCIA HOMECARE, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/05/2006
Last Update Date: 09/12/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

VIA MIRTA 3KS5 VILLA FONTANA
CAROLINA PR
00983-4639
US

IV. Provider business mailing address

VIA MIRTA 3KS5 VILLA FONTANA
CAROLINA PR
00983-4639
US

V. Phone/Fax

Practice location:
  • Phone: 787-762-0889
  • Fax:
Mailing address:
  • Phone: 787-762-0889
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License Number08B3316
License Number StatePR

VIII. Authorized Official

Name: MR. MILTON CRUZ
Title or Position: PRESIDENT
Credential:
Phone: 787-706-5255