MEDICARE: PUERTO RICO CARE RESPONSE HOME HEALTH AGENCY CORP.

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

General Provider Information

NPI Number	:	1194919308
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	PUERTO RICO CARE RESPONSE HOME HEALTH AGENCY CORP.

Provider Business Mailing Address
First Line	:	AVE. LAS AMERICAS
Second Line	:	URB. CONSTANCIA # 2644-A
City	:	PONCE
State	:	PR
Zip	:	00717
Country	:	US
Telephone Number	:	787-290-2351
Fax Number	:	787-290-2352

Provider Business Practice Location Address
First Line	:	AVE. LAS AMERICAS
Second Line	:	URB. CONSTANCIA # 2644-A
City	:	PONCE
State	:	PR
Zip	:	00717
Country	:	US
Telephone Number	:	787-290-2351
Fax Number	:	787-290-2352

Authorized Official
Title or Position	:	OWNER
Name	:	MRS. SANDRA GOTAY
Credential	:	RN
Telephone Number	:	305-644-4560

Provider Enumeration Date	:	08/30/2007
Last Update Date	:	08/30/2007

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