Healthcare Provider Details

I. General information

NPI: 1083129811
Provider Name (Legal Business Name): HOGAR LOS LIRIOS II
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/01/2017
Last Update Date: 12/01/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

Y1-19 CALLE XSIPIBU
SAN JUAN PR
00926-2225
US

IV. Provider business mailing address

Y1-19 CALLE XSIPIBU
SAN JUAN PR
00926-2225
US

V. Phone/Fax

Practice location:
  • Phone: 787-484-9493
  • Fax:
Mailing address:
  • Phone: 787-484-9493
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251J00000X
TaxonomyNursing Care Agency
License Number
License Number StatePR

VIII. Authorized Official

Name: MRS. HAYMAR MERCED
Title or Position: VICE PRESIDENTA
Credential:
Phone: 787-484-9493