Healthcare Provider Details

I. General information

NPI: 1396501698
Provider Name (Legal Business Name): HOGAR MI DULCE ESTANCIA LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/23/2024
Last Update Date: 08/14/2026
Certification Date: 08/14/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

CARR 472 KM 1.0 CALLE CASIMIRO DE CASTRO #132 BO BEJUCOS
ISABELA PR
00662
US

IV. Provider business mailing address

2483 PLAYUELA APT 18
AGUADILLA PR
00603-6150
US

V. Phone/Fax

Practice location:
  • Phone: 787-448-8497
  • Fax:
Mailing address:
  • Phone: 787-448-8497
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208D00000X
TaxonomyGeneral Practice Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code314000000X
TaxonomySkilled Nursing Facility
License Number
License Number State

VIII. Authorized Official

Name: FRANCES RIOS ROLDAN
Title or Position: ADMINISTRATOR
Credential: MD
Phone: 787-448-8497