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General NPI Number Information
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NPI Number | 1275541500
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Entity Type | Organization
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Legal Business Name | JERUSALEN HOME AMBULANCE, INC.
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Dates
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Enumeration Date | 08/03/2006
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Last Update Date | 02/21/2014
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Provider Practice Location Address
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Address Line | AVE LUIS MUNOZ MARIN ESQUINA GEORGETTI ANGORA PARK PLAZA
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City | CAGUAS
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State | PR
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Zip | 00725
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Country | US
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Telephone | 787-653-1717
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Fax | 787-653-1720
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Provider Business Mailing Address
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Address Line | PO BOX 1780
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City | CAGUAS
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State | PR
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Zip | 00726-1780
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Country | US
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Telephone | 787-653-2225
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Fax | 787-653-1720
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Authorized Official
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Title or Position | DIRECTOR
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Name | MR. LUIS ORTIZ
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Credential |
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Telephone | 787-653-2225
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 3416L0300X
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Taxonomy Name | Land Ambulance
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License Number | TCAMB-164
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License Number State | PR
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Taxonomy #2
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Taxonomy Code | 3416L0300X
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Taxonomy Name | Land Ambulance
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License Number | TCAMB-361
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License Number State | PR
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