MEDICARE: CONDADO HOSPICE PROGRAM, 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	251G00000X	Community Based Hospice Care Agency

General Provider Information

NPI Number	:	1750382743
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	CONDADO HOSPICE PROGRAM, INC

Provider Business Mailing Address
First Line	:	186 CALLE JUAN P DUARTE
Second Line	:	FLORAL PARK
City	:	HATO REY
State	:	PR
Zip	:	00917-3602
Country	:	US
Telephone Number	:	787-758-4310
Fax Number	:	787-758-4315

Provider Business Practice Location Address
First Line	:	186 CALLE JUAN P DUARTE
Second Line	:	FLORAL PARK
City	:	HATO REY
State	:	PR
Zip	:	00917-3602
Country	:	US
Telephone Number	:	787-758-4310
Fax Number	:	787-758-4315

Authorized Official
Title or Position	:	VICE PRESIDENT OF SERVICES
Name	:	MARIA DE LOURDES DE LEON
Credential	:	MS
Telephone Number	:	787-758-4310

Provider Enumeration Date	:	08/02/2005
Last Update Date	:	01/22/2010

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Directions to “CONDADO HOSPICE PROGRAM, INC ” Practice Location

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