Provider Demographics
NPI:1366591018
Name:SAINT LUKES EPISCOPAL CHURCH HOME CARE PROGRAM
Entity type:Organization
Organization Name:SAINT LUKES EPISCOPAL CHURCH HOME CARE PROGRAM
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:GERENTE FACTURACION Y COBRES
Authorized Official - Prefix:MRS
Authorized Official - First Name:MAYRA
Authorized Official - Middle Name:
Authorized Official - Last Name:HERNANDEZ
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:787-843-5855
Mailing Address - Street 1:PO BOX 7064
Mailing Address - Street 2:
Mailing Address - City:PONCE
Mailing Address - State:PR
Mailing Address - Zip Code:00732-7064
Mailing Address - Country:US
Mailing Address - Phone:787-843-4185
Mailing Address - Fax:787-843-5850
Practice Address - Street 1:291 CALLE MONTERREY
Practice Address - Street 2:
Practice Address - City:PONCE
Practice Address - State:PR
Practice Address - Zip Code:00717-1376
Practice Address - Country:US
Practice Address - Phone:787-843-4185
Practice Address - Fax:787-843-5850
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:SAINT LUKES EPISCOPAL CHURCH HOME CARE PROGRAM
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2007-01-10
Last Update Date:2008-07-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR660289157OtherCIGNA
PR9800093OtherACAA
PR1-9485STOtherTRIPLE S
PR071002OtherCRUZ AZUL
PR7330102OtherHUMANA
PR9800093OtherACAA