MEDICARE: HOGAR DONA ANA, INC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	311ZA0620X	Adult Care Home Facility	309	PR

General Provider Information

NPI Number	:	1124358817
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	HOGAR DONA ANA, INC

Provider Business Mailing Address
First Line	:	LEVITTOWN LAKES
Second Line	:	FF5 JOSE DE DIEGO 6TA. SECCION
City	:	TOA BAJA
State	:	PR
Zip	:	00949
Country	:	US
Telephone Number	:	787-642-2037
Fax Number	:

Provider Business Practice Location Address
First Line	:	LEVITTOWN LAKES
Second Line	:	FF5 JOSE DE DIEGO 6TA SECCION
City	:	TOA BAJA
State	:	PR
Zip	:	00949-0000
Country	:	US
Telephone Number	:	787-642-2037
Fax Number	:

Authorized Official
Title or Position	:	GENERAL MANAGER
Name	:	MRS. MABEL MIRANDA MALDONADO
Credential	:
Telephone Number	:	787-642-2037

Provider Enumeration Date	:	01/04/2010
Last Update Date	:	01/04/2010

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