Healthcare Provider Details

I. General information

NPI: 1336133503
Provider Name (Legal Business Name): ST LUKES EPISCOPAL CHURCH HOME CARE PROGRAM
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/02/2005
Last Update Date: 12/16/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

WESTERN AUTO PLAZA EXPRESO TRUJILLO ALTO
TRUJILLO ALTO PR
00978
US

IV. Provider business mailing address

APARTADO 912 SAINT JUST STATION
TRUJILLO ALTO PR
00978
US

V. Phone/Fax

Practice location:
  • Phone: 787-843-4185
  • Fax: 787-843-5850
Mailing address:
  • Phone: 787-843-4185
  • Fax: 787-843-5850

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License Number32
License Number StatePR

VIII. Authorized Official

Name: MS. ISUANET CASTILLO
Title or Position: OPERATIONAL EXECUTIVE DIRECTOR
Credential: CPA
Phone: 787-843-4185