Healthcare Provider Details

I. General information

NPI: 1013909712
Provider Name (Legal Business Name): ST LUKES EPISCOPAL CHURCH HOME CARE PROGRAM
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/18/2005
Last Update Date: 08/07/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

SECTOR MELANIA CARR. #3 CENTRO COMERCIAL SAN VICENTE MALL
GUAYAMA PR
00784-9601
US

IV. Provider business mailing address

RR1 BOX 6091
GUAYAMA PR
00784-9601
US

V. Phone/Fax

Practice location:
  • Phone: 787-843-4185
  • Fax: 787-259-7135
Mailing address:
  • Phone: 787-843-4185
  • Fax: 787-259-7135

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License Number26
License Number StatePR

VIII. Authorized Official

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