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General NPI Number Information
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NPI Number | 1083150262
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Entity Type | Organization
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Legal Business Name | HOGAR LUZ DE VIDA INC
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Dates
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Enumeration Date | 01/12/2017
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Last Update Date | 01/12/2017
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Provider Practice Location Address
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Address Line | CARR 108 KM 10.9 RAMAL 4430 INTERIOR BO LEQUISAMO
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City | MAYAGUEZ
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State | PR
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Zip | 00681
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Country | US
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Telephone | 787-833-1508
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 219
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City | MAYAGUEZ
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State | PR
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Zip | 00681-0219
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Country | US
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Telephone | 787-833-1508
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Fax |
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Authorized Official
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Title or Position | EXECUTIVE DIRECTOR
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Name | MR. WALTER ORLANDO PEREZ-RODRIGUEZ
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Credential |
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Telephone | 787-410-0781
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 324500000X
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Taxonomy Name | Substance Abuse Rehabilitation Facility
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License Number | 0348
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License Number State | PR
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