Healthcare Provider Details

I. General information

NPI: 1174615512
Provider Name (Legal Business Name): HOME HEALTH PROVIDERS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/29/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

CALLE LAS PALMAS # 97
SAN JUAN PR
00911
US

IV. Provider business mailing address

CALLE LAS PALMAS # 97
SAN JUAN PR
00911
US

V. Phone/Fax

Practice location:
  • Phone: 787-728-7326
  • Fax: 787-728-7326
Mailing address:
  • Phone: 787-728-7326
  • Fax: 787-728-7326

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code302F00000X
TaxonomyExclusive Provider Organization
License Number4122
License Number StatePR

VIII. Authorized Official

Name: PEDRO RAFAEL BADILLO
Title or Position: PRESIDENT
Credential: M.D.
Phone: 787-638-7648