Provider Demographics
NPI:1962588285
Name:CONDADO HOME CARE, INC.
Entity type:Organization
Organization Name:CONDADO HOME CARE, INC.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:CARMEN
Authorized Official - Middle Name:LYDIA
Authorized Official - Last Name:TORRES
Authorized Official - Suffix:
Authorized Official - Credentials:MASTERS IN ECONOMY
Authorized Official - Phone:787-758-8180
Mailing Address - Street 1:409 CALLE BEGONIA
Mailing Address - Street 2:QUINTAS DE CAMPECHE
Mailing Address - City:CAROLINA
Mailing Address - State:PR
Mailing Address - Zip Code:00987-7159
Mailing Address - Country:US
Mailing Address - Phone:787-607-3943
Mailing Address - Fax:787-276-5457
Practice Address - Street 1:186 CALLE JUAN P DUARTE
Practice Address - Street 2:HATO REY
Practice Address - City:SAN JUAN
Practice Address - State:PR
Practice Address - Zip Code:00917-3602
Practice Address - Country:US
Practice Address - Phone:787-758-8180
Practice Address - Fax:787-274-1571
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-29
Last Update Date:2008-06-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR407011251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health