Healthcare Provider Details

I. General information

NPI: 1023011376
Provider Name (Legal Business Name): HOSPICIO LA GUADALUPE INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/31/2005
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

CARR #14 ANEXO HOSP ONCOLOGICO
PONCE PR
00732-0000
US

IV. Provider business mailing address

PO BOX 7699
PONCE PR
00732-7699
US

V. Phone/Fax

Practice location:
  • Phone: 787-259-8210
  • Fax:
Mailing address:
  • Phone: 787-259-8210
  • Fax: 787-259-8205

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: MRS. LUZ M GONZALEZ
Title or Position: ADMINISTRATOR
Credential:
Phone: 787-259-8210