MEDICARE: PROGRAMA DE SERVICIOS DE SALUD EN EL HOGAR DEL NORTE, 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	407029	PR

General Provider Information

NPI Number	:	1790777266
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	PROGRAMA DE SERVICIOS DE SALUD EN EL HOGAR DEL NORTE, INC.

Provider Business Mailing Address
First Line	:	PO BOX 143114
Second Line	:
City	:	ARECIBO
State	:	PR
Zip	:	00614-3114
Country	:	US
Telephone Number	:	787-898-1009
Fax Number	:	787-262-8737

Provider Business Practice Location Address
First Line	:	BO HATO ABAJO SECTOR BARRANCA CARR 653 KM 2.0
Second Line	:
City	:	ARECIBO
State	:	PR
Zip	:	00612-0000
Country	:	US
Telephone Number	:	787-898-1009
Fax Number	:	787-262-8737

Authorized Official
Title or Position	:	EXECUTIVE DIRECTOR
Name	:	MS. GLORIA A DELGADO
Credential	:	MD
Telephone Number	:	787-898-1009

Provider Enumeration Date	:	08/19/2005
Last Update Date	:	03/05/2012

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