Healthcare Provider Details

I. General information

NPI: 1750382743
Provider Name (Legal Business Name): CONDADO HOSPICE PROGRAM, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/02/2005
Last Update Date: 01/22/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

186 CALLE JUAN P DUARTE FLORAL PARK
HATO REY PR
00917-3602
US

IV. Provider business mailing address

186 CALLE JUAN P DUARTE FLORAL PARK
HATO REY PR
00917-3602
US

V. Phone/Fax

Practice location:
  • Phone: 787-758-4310
  • Fax: 787-758-4315
Mailing address:
  • Phone: 787-758-4310
  • Fax: 787-758-4315

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251G00000X
TaxonomyCommunity Based Hospice Care Agency
License Number
License Number State

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name: MARIA DE LOURDES DE LEON
Title or Position: VICE PRESIDENT OF SERVICES
Credential: MS
Phone: 787-758-4310