Provider Demographics
NPI:1386765444
Name:EMMANUEL HOSPICE CARE, INCORPORADO
Entity type:Organization
Organization Name:EMMANUEL HOSPICE CARE, INCORPORADO
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:MOISES
Authorized Official - Middle Name:
Authorized Official - Last Name:RIVERA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:787-897-7040
Mailing Address - Street 1:PO BOX 1336
Mailing Address - Street 2:
Mailing Address - City:LARES
Mailing Address - State:PR
Mailing Address - Zip Code:00669-1336
Mailing Address - Country:US
Mailing Address - Phone:787-897-7040
Mailing Address - Fax:787-897-0015
Practice Address - Street 1:CARR 129 INTERSECCION 415
Practice Address - Street 2:KM0 HM0
Practice Address - City:LARES
Practice Address - State:PR
Practice Address - Zip Code:00669
Practice Address - Country:US
Practice Address - Phone:787-897-7040
Practice Address - Fax:787-897-0015
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-03
Last Update Date:2013-04-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251G00000XAgenciesHospice Care, Community Based
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR401516Medicare ID - Type UnspecifiedHOSPICE CARE