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General NPI Number Information
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NPI Number | 1013901123
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Entity Type | Organization
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Legal Business Name | ST LUKES EPISCOPAL CHURCH HOME CARE PROGRAM
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Dates
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Enumeration Date | 09/02/2005
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Last Update Date | 07/24/2008
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Provider Practice Location Address
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Address Line | CARR #2 KM 124.9 BO CIMITAL BAJO
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City | AGUADILLA
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State | PR
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Zip | 00605
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Country | US
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Telephone | 787-843-4185
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Fax | 787-843-5850
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Provider Business Mailing Address
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Address Line | APARTADO 1809 VICTORIA STATION
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City | AGUADILLA
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State | PR
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Zip | 00605
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Country | US
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Telephone | 787-843-4185
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Fax | 787-843-5850
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Authorized Official
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Title or Position | GERENTE FACHTURANCION Y COBRO
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Name | MRS. MAYRA HERNANDEZ
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Credential |
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Telephone | 787-843-5855
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251E00000X
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Taxonomy Name | Home Health Agency
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License Number | 42
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License Number State | PR
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