Healthcare Provider Details

I. General information

NPI: 1265426258
Provider Name (Legal Business Name): ST LUKES EPISCOPAL CHURCH HOME CARE PROGRAM
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/06/2005
Last Update Date: 07/24/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

CALLE MENDEZ VIGO #201 OESTE
MAYAGUEZ PR
00680
US

IV. Provider business mailing address

CALLE MENDEZ VIGO #201 OESTE
MAYAGUEZ PR
00680
US

V. Phone/Fax

Practice location:
  • Phone: 787-843-4185
  • Fax: 787-843-5855
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 Number39
License Number StatePR

VIII. Authorized Official

Name: MRS. MAYRA HERNANDEZ
Title or Position: GERENTE FACTURACION & COBRO
Credential:
Phone: 787-843-5855