Healthcare Provider Details

I. General information

NPI: 1689724882
Provider Name (Legal Business Name): IV HOME THERAPY CORP
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/11/2007
Last Update Date: 02/04/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

CARR VIEJA HACIA GUAYANILLA BDA BALDORITY #579
PONCE PR
00717-1789
US

IV. Provider business mailing address

LOS MAESTROS CALLE MARTIN CORCHADO #8234
PONCE PR
00717-0254
US

V. Phone/Fax

Practice location:
  • Phone: 787-507-0371
  • Fax:
Mailing address:
  • Phone: 787-507-0371
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License Number51
License Number StatePR
# 2
Primary TaxonomyN
Taxonomy Code251F00000X
TaxonomyHome Infusion Agency
License Number06-059
License Number StatePR
# 3
Primary TaxonomyN
Taxonomy Code261QM1300X
TaxonomyMulti-Specialty Clinic/Center
License Number1689724882
License Number StatePR
# 4
Primary TaxonomyN
Taxonomy Code332BP3500X
TaxonomyParenteral & Enteral Nutrition Supplies (DME)
License Number5275690001
License Number StatePR
# 5
Primary TaxonomyY
Taxonomy Code251J00000X
TaxonomyNursing Care Agency
License Number51
License Number StatePR

VIII. Authorized Official

Name: MR. JAMES E. JOHNSON RODRIGUEZ SR.
Title or Position: PRESIDENT
Credential: LPN
Phone: 787-507-0371