Healthcare Provider Details

I. General information

NPI: 1669868188
Provider Name (Legal Business Name): CASA DE SALUD DEL ESTE INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/10/2015
Last Update Date: 02/27/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

URB MONTE VISTA CALLE IGUALDAD LOTE C-2
FAJARDO PR
00738-1165
US

IV. Provider business mailing address

PO BOX 1165
FAJARDO P PR
00738-1165
US

V. Phone/Fax

Practice location:
  • Phone: 787-863-8444
  • Fax: 787-863-8445
Mailing address:
  • Phone: 787-863-8444
  • Fax: 787-863-8445

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code314000000X
TaxonomySkilled Nursing Facility
License Number#6
License Number StatePR

VIII. Authorized Official

Name: DIARAM AMRUD
Title or Position: CEO
Credential: MD
Phone: 787-402-8444