Healthcare Provider Details

I. General information

NPI: 1750873766
Provider Name (Legal Business Name): RYDER MEMORIAL HOSPITAL INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/05/2018
Last Update Date: 06/05/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

355 AVE FONT MARTELO
HUMACAO PR
00791-3249
US

IV. Provider business mailing address

PO BOX 859
HUMACAO PR
00792-0859
US

V. Phone/Fax

Practice location:
  • Phone: 787-852-0768
  • Fax: 787-852-0157
Mailing address:
  • Phone: 787-852-0768
  • Fax: 787-852-0157

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code314000000X
TaxonomySkilled Nursing Facility
License Number405018
License Number StatePR

VIII. Authorized Official

Name: JOSE R FELICIANO
Title or Position: EXECUTIVE DIRECTOR
Credential:
Phone: 787-852-0882