Provider Demographics
NPI:1528273992
Name:VEGA ALTA HOSPICE CARE, INC.
Entity type:Organization
Organization Name:VEGA ALTA HOSPICE CARE, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:MISS
Authorized Official - First Name:ITZALIA
Authorized Official - Middle Name:
Authorized Official - Last Name:TIRADO VALENTIN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:787-270-4838
Mailing Address - Street 1:PO BOX 459
Mailing Address - Street 2:
Mailing Address - City:VEGA ALTA
Mailing Address - State:PR
Mailing Address - Zip Code:00692
Mailing Address - Country:US
Mailing Address - Phone:787-270-4838
Mailing Address - Fax:787-270-4972
Practice Address - Street 1:CALLE MUNOZ RIVERA #1
Practice Address - Street 2:
Practice Address - City:VEGA ALTA
Practice Address - State:PR
Practice Address - Zip Code:00692
Practice Address - Country:US
Practice Address - Phone:787-270-4838
Practice Address - Fax:787-270-4972
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-11
Last Update Date:2007-10-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR401565251G00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251G00000XAgenciesHospice Care, Community Based
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR401565Medicare ID - Type UnspecifiedHOSPICE