MEDICARE: ST LUKES EPISCOPAL CHURCH HOME CARE PROGRAM

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	251E00000X	Home Health Agency	23	PR

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	9800093	OTHER	PR	ACAA
2	071002	OTHER	PR	CRUZ AZUL
3	7330102	OTHER	PR	HUMANA
4	1-9485ST	OTHER	PR	TRIPLE S

General Provider Information

NPI Number	:	1144229915
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ST LUKES EPISCOPAL CHURCH HOME CARE PROGRAM

Provider Business Mailing Address
First Line	:	CALLE CARRION MADURO
Second Line	:	ESQ CALLEJON LAS MARIAS
City	:	JUANA DIAZ
State	:	PR
Zip	:	00795
Country	:	US
Telephone Number	:	787-843-4185
Fax Number	:	787-843-5850

Provider Business Practice Location Address
First Line	:	CALLE CARRION MADURO
Second Line	:	ESQ CALLEJON LAS MARIAS
City	:	JUANA DIAZ
State	:	PR
Zip	:	00795
Country	:	US
Telephone Number	:	787-843-4185
Fax Number	:	787-843-5850

Authorized Official
Title or Position	:	OPERATIONAL EXECUTIVE DIRECTOR
Name	:	ISUANET CASTILLO
Credential	:	CPA
Telephone Number	:	787-843-4185

Provider Enumeration Date	:	07/14/2005
Last Update Date	:	03/21/2013

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