=====================================================
General NPI Number Information
=====================================================
NPI Number | 1609491208
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | HOGAR LAS AGUILAS INCORPORADO
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 06/10/2020
-----------------------------------------------------
Last Update Date | 06/10/2020
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | LA RAMBLA OFFICE PARK 621 CARR 14 CALLE MARGINAL
-----------------------------------------------------
City | PONCE
-----------------------------------------------------
State | PR
-----------------------------------------------------
Zip | 00716
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 787-284-6785
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 1575 PMB 193 AVE MUNOZ RIVERA
-----------------------------------------------------
City | PONCE
-----------------------------------------------------
State | PR
-----------------------------------------------------
Zip | 00717
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 787-284-6785
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PRESIDENT
-----------------------------------------------------
Name | MS. EMELISA BERMUDEZ
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 787-640-1862
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 311ZA0620X
-----------------------------------------------------
Taxonomy Name | Adult Care Home Facility
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------