Provider Demographics
NPI:1104088608
Name:HOSPICIO SANTA RITA, INC.
Entity type:Organization
Organization Name:HOSPICIO SANTA RITA, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BILLING OFFICER
Authorized Official - Prefix:MRS
Authorized Official - First Name:OLGA
Authorized Official - Middle Name:LYDIA
Authorized Official - Last Name:DE JESUS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:787-589-0003
Mailing Address - Street 1:PO BOX 1143
Mailing Address - Street 2:
Mailing Address - City:AGUADA
Mailing Address - State:PR
Mailing Address - Zip Code:00602-1143
Mailing Address - Country:US
Mailing Address - Phone:787-589-0003
Mailing Address - Fax:787-252-0854
Practice Address - Street 1:SUITE 210, CARR, 2 KM 1.59
Practice Address - Street 2:EDIF. MEDICAL EMPORIUM
Practice Address - City:MAYAGUEZ
Practice Address - State:PR
Practice Address - Zip Code:00680-1143
Practice Address - Country:US
Practice Address - Phone:787-652-1295
Practice Address - Fax:787-652-1297
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-06-26
Last Update Date:2013-08-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR251G00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251G00000XAgenciesHospice Care, Community Based
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR401554Medicare Oscar/Certification