Provider Demographics
NPI:1063147387
Name:PROGRAMA DE SERVICIOS DE SALUD EN EL HOGAR Y HOSPICIO SAN LUCAS, INC.
Entity type:Organization
Organization Name:PROGRAMA DE SERVICIOS DE SALUD EN EL HOGAR Y HOSPICIO SAN LUCAS, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTORA EJECUTIVA OPERACIONAL
Authorized Official - Prefix:
Authorized Official - First Name:ISUANET
Authorized Official - Middle Name:
Authorized Official - Last Name:CASTILLO MEDINA
Authorized Official - Suffix:
Authorized Official - Credentials:CPA
Authorized Official - Phone:787-843-4185
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:787-878-5819
Mailing Address - Fax:787-879-4321
Practice Address - Street 1:CARR 2, KM 81.0
Practice Address - Street 2:OFFICE 203, CARIBBEAN CINEMAS BLDG
Practice Address - City:ARECIBO
Practice Address - State:PR
Practice Address - Zip Code:00612-2040
Practice Address - Country:US
Practice Address - Phone:787-878-5819
Practice Address - Fax:787-879-4321
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-07-20
Last Update Date:2022-12-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health