Healthcare Provider Details

I. General information

NPI: 1437202785
Provider Name (Legal Business Name): OHI OF PUERTO RICO, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/19/2007
Last Update Date: 03/18/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

PLAZA DEL CARIBE 2050 STE 269
PONCE PR
00717-1312
US

IV. Provider business mailing address

275 ROUTE 22
SPRINGFIELD NJ
07081-3554
US

V. Phone/Fax

Practice location:
  • Phone: 787-840-0909
  • Fax:
Mailing address:
  • Phone: 917-716-7666
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code332H00000X
TaxonomyEyewear Supplier
License Number
License Number State

VIII. Authorized Official

Name: MR. ISAIAS CALDERON
Title or Position: DIRECTOR; ASSIGNMENT OPERATIONS
Credential:
Phone: 787-925-1851