MEDICARE: CARIBBEAN HOSPICE CORPORATION

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	251G00000X	Community Based Hospice Care Agency	04-079	PR

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	1-9943	OTHER		TRIPLE S INC

General Provider Information

NPI Number	:	1306846878
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	CARIBBEAN HOSPICE CORPORATION

Provider Business Mailing Address
First Line	:	WINSTON CHURCHILL AVENUE
Second Line	:	#153 CROWN HILLS
City	:	SAN JUAN
State	:	PR
Zip	:	00926-6012
Country	:	US
Telephone Number	:	787-764-6555
Fax Number	:	787-758-3035

Provider Business Practice Location Address
First Line	:	WINSTON CHURCHILL AVENUE
Second Line	:	#153 CROWN HILLS
City	:	SAN JUAN
State	:	PR
Zip	:	00926-6012
Country	:	US
Telephone Number	:	787-764-6555
Fax Number	:	787-758-3035

Authorized Official
Title or Position	:	EXECUTIVE DIRECTOR
Name	:	MRS. AMNERIS OMS SANDOVAL
Credential	:
Telephone Number	:	787-764-6555

Provider Enumeration Date	:	07/27/2005
Last Update Date	:	01/23/2014

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Directions to “CARIBBEAN HOSPICE CORPORATION ” Practice Location

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