MEDICARE: PUERTO RICAN HOME ATTENDANTS SERVICES, 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	251E00000X	Home Health Agency	9911L001	NY

General Provider Information

NPI Number	:	1518032416
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	PUERTO RICAN HOME ATTENDANTS SERVICES, INC

Provider Business Mailing Address
First Line	:	564 SOUTHERN BLVD FL 2
Second Line	:
City	:	BRONX
State	:	NY
Zip	:	10455-3715
Country	:	US
Telephone Number	:	718-292-8770
Fax Number	:	718-585-2114

Provider Business Practice Location Address
First Line	:	564 SOUTHERN BLVD FL 2
Second Line	:
City	:	BRONX
State	:	NY
Zip	:	10455-3715
Country	:	US
Telephone Number	:	718-292-8770
Fax Number	:	718-585-2114

Authorized Official
Title or Position	:	EXECUTIVE DIRECTOR
Name	:	MR. JUAN HERNANDEZ
Credential	:
Telephone Number	:	718-292-8770

Provider Enumeration Date	:	11/24/2006
Last Update Date	:	08/22/2020

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