Healthcare Provider Details

I. General information

NPI: 1952395055
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: 12/16/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

EDIF. CARIBBEAN CINEMAS, OFIC. 207 PUNTA DEL ESTE SHOPPING CENTER
FAJARDO PR
00738
US

IV. Provider business mailing address

PO BOX 70005 SUITE 197
FAJARDO PR
00738
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 Number40
License Number StatePR

VIII. Authorized Official

Name: MS. ISUANET CASTILLO
Title or Position: OPERATIONAL EXECUTIVE DIRECTOR
Credential: CPA
Phone: 787-843-4185