Healthcare Provider Details

I. General information

NPI: 1144930207
Provider Name (Legal Business Name): MENNONITE GENERAL HOSPITAL, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/30/2022
Last Update Date: 11/30/2022
Certification Date: 11/23/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

CARR PR 506 KM 1.0, BO COTO LAUREL
PONCE PR
00780-0000
US

IV. Provider business mailing address

PO BOX 1650
CIDRA PR
00739-1650
US

V. Phone/Fax

Practice location:
  • Phone: 787-434-1700
  • Fax: 787-434-1711
Mailing address:
  • Phone: 787-434-1700
  • Fax: 787-434-1711

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License Number
License Number State

VIII. Authorized Official

Name: LISSETTE VAZQUEZ RIVERA
Title or Position: DIRECTOR
Credential:
Phone: 787-434-1700