Healthcare Provider Details

I. General information

NPI: 1770584765
Provider Name (Legal Business Name): CONDADO HOME CARE PROGRAM, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/02/2005
Last Update Date: 01/27/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

186 CALLE JUAN P DUARTE FLORAL PARK
SAN JUAN PR
00917-3602
US

IV. Provider business mailing address

186 CALLE JUAN P DUARTE FLORAL PARK
SAN JUAN PR
00917-3602
US

V. Phone/Fax

Practice location:
  • Phone: 787-758-8180
  • Fax: 787-274-1571
Mailing address:
  • Phone: 787-758-8180
  • Fax: 787-274-1571

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License Number
License Number State

VIII. Authorized Official

Name: MARIA DE LOURDES DE LEON
Title or Position: VICE PRESIDENT OF SERVICES
Credential: MS
Phone: 787-758-8180