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General NPI Number Information
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NPI Number | 1598997520
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Entity Type | Organization
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Legal Business Name | SAN JUAN HEART, LLC
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Dates
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Enumeration Date | 08/09/2009
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Last Update Date | 08/09/2009
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Provider Practice Location Address
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Address Line | 625 MAIN AVE
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City | PASSAIC
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State | NJ
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Zip | 07055-4952
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Country | US
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Telephone | 973-458-8292
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Fax | 973-777-1637
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Provider Business Mailing Address
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Address Line | 39 AYCRIGG AVE
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City | PASSAIC
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State | NJ
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Zip | 07055-5664
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Country | US
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Telephone | 973-458-8292
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Fax | 973-777-1637
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Authorized Official
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Title or Position | CEO
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Name | JUAN DE LA CRUZ
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Credential |
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Telephone | 973-458-8292
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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 | HP0046601
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License Number State | NJ
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