Healthcare Provider Details

I. General information

NPI: 1891793667
Provider Name (Legal Business Name): ST LUKES EPISCOPAL CHURCH HOME CARE PROGRAM
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/14/2005
Last Update Date: 06/15/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

917 AVE TITO CASTRO HOSPITAL EPISCOPAL SAN LUCAS
PONCE PR
00716-4717
US

IV. Provider business mailing address

PO BOX 7064
PONCE PR
00732-7064
US

V. Phone/Fax

Practice location:
  • Phone: 787-843-4185
  • Fax: 787-843-5850
Mailing address:
  • Phone: 787-843-4185
  • Fax: 787-843-5850

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code332BP3500X
TaxonomyParenteral & Enteral Nutrition Supplies (DME)
License Number
License Number State

VIII. Authorized Official

Name: MS. ISUANET CASTILLO
Title or Position: OPERATIONAL EXECUTIVE DIRECTOR
Credential: CPA
Phone: 787-843-4185