Provider Demographics
NPI:1699734707
Name:HOSPICIO DIVINO SALVADOR, INC.
Entity type:Organization
Organization Name:HOSPICIO DIVINO SALVADOR, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:GUILLERMO
Authorized Official - Middle Name:
Authorized Official - Last Name:REYES
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:787-855-0411
Mailing Address - Street 1:PO BOX 1450
Mailing Address - Street 2:
Mailing Address - City:VEGA BAJA
Mailing Address - State:PR
Mailing Address - Zip Code:00694-1450
Mailing Address - Country:US
Mailing Address - Phone:787-855-0411
Mailing Address - Fax:787-855-0285
Practice Address - Street 1:CARR. 2 KM. 40.2 PLAZA JARDINES
Practice Address - Street 2:SUITE 8
Practice Address - City:VEGA BAJA
Practice Address - State:PR
Practice Address - Zip Code:00693
Practice Address - Country:US
Practice Address - Phone:787-855-0411
Practice Address - Fax:787-855-0285
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-03-20
Last Update Date:2017-01-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR31251G00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251G00000XAgenciesHospice Care, Community Based
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR401562Medicare ID - Type UnspecifiedHOSPICE