Healthcare Provider Details

I. General information

NPI: 1508216763
Provider Name (Legal Business Name): HERMANITAS ANCIANOS DESAMPARADOS HOGAR NUESTRA SENORA DE LA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/20/2016
Last Update Date: 06/20/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

205 AVE CONSTITUTION
SAN JUAN PR
00902-4006
US

IV. Provider business mailing address

PO BOX 9024006
SAN JUAN PR
00902-4006
US

V. Phone/Fax

Practice location:
  • Phone: 787-722-1331
  • Fax: 787-725-4308
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code314000000X
TaxonomySkilled Nursing Facility
License Number
License Number StatePR

VIII. Authorized Official

Name: GLADYS ROSARIO
Title or Position: DIRECTOR
Credential: REGISTER NURSE
Phone: 787-722-1331