Healthcare Provider Details

I. General information

NPI: 1144229915
Provider Name (Legal Business Name): ST LUKES EPISCOPAL CHURCH HOME CARE PROGRAM
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/14/2005
Last Update Date: 03/21/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

CALLE CARRION MADURO ESQ CALLEJON LAS MARIAS
JUANA DIAZ PR
00795
US

IV. Provider business mailing address

CALLE CARRION MADURO ESQ CALLEJON LAS MARIAS
JUANA DIAZ PR
00795
US

V. Phone/Fax

Practice location:
  • Phone: 787-843-4185
  • Fax: 787-843-5850
Mailing address:
  • Phone: 787-843-4185
  • Fax: 787-843-5850

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License Number23
License Number StatePR

VIII. Authorized Official

Name: ISUANET CASTILLO
Title or Position: OPERATIONAL EXECUTIVE DIRECTOR
Credential: CPA
Phone: 787-843-4185