Healthcare Provider Details

I. General information

NPI: 1942345046
Provider Name (Legal Business Name): CENTRO DE EDAD DE ORO, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/20/2007
Last Update Date: 08/07/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1557 CALLE SALUD
PONCE PR
00730-5820
US

IV. Provider business mailing address

1557 SALUD & TRICOCHE
PONCE PR
00730-5820
US

V. Phone/Fax

Practice location:
  • Phone: 787-504-8263
  • Fax: 787-841-2366
Mailing address:
  • Phone: 787-504-8263
  • Fax: 787-841-2366

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QA0600X
TaxonomyAdult Day Care Clinic/Center
License Number1032
License Number StatePR

VIII. Authorized Official

Name: MR. RAMON CARDONA SR.
Title or Position: DIRECTOR
Credential:
Phone: 787-504-8263