Healthcare Provider Details

I. General information

NPI: 1639113301
Provider Name (Legal Business Name): WESTERN MEDICAL HOSPICE, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/15/2006
Last Update Date: 08/13/2024
Certification Date: 08/13/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

#4040 CALLE B LOTE 30 ZONA INDUSTRIAL GUANAJIBO, SUITE 4,
MAYAGUEZ PR
00682-1378
US

IV. Provider business mailing address

PO BOX 8174 MARINA STATION
MAYAGUEZ PR
00681-8174
US

V. Phone/Fax

Practice location:
  • Phone: 787-831-2252
  • Fax: 787-834-6220
Mailing address:
  • Phone: 787-833-5898
  • Fax: 787-832-3795

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: DR. LUIS HORACIO RUIZ
Title or Position: EXECUTIVE DIRECTOR
Credential: M.D.
Phone: 787-833-5898