Provider Demographics
NPI:1093914947
Name:EL GERONTE EDERLY SERVICES INC
Entity Type:Organization
Organization Name:EL GERONTE EDERLY SERVICES INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:GERONTOLOGY ADMINISTRATOR
Authorized Official - Prefix:MR
Authorized Official - First Name:MANUEL
Authorized Official - Middle Name:ENRIQUE
Authorized Official - Last Name:CABALLERO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:787-739-8170
Mailing Address - Street 1:URB HACIENDA PRIMAVERA BOX 56
Mailing Address - Street 2:
Mailing Address - City:CIDRA
Mailing Address - State:PR
Mailing Address - Zip Code:00739-9372
Mailing Address - Country:US
Mailing Address - Phone:787-714-3731
Mailing Address - Fax:
Practice Address - Street 1:CARR 171 KM 4.4
Practice Address - Street 2:BARRIO RINCON
Practice Address - City:CIDRA
Practice Address - State:PR
Practice Address - Zip Code:00739
Practice Address - Country:US
Practice Address - Phone:787-714-3731
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-07-12
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR3140N1450X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3140N1450XNursing & Custodial Care FacilitiesSkilled Nursing FacilityNursing Care, Pediatric