Provider Demographics
NPI:1184658775
Name:CUIDADO CASERO MAYAGUEZ, INC.
Entity Type:Organization
Organization Name:CUIDADO CASERO MAYAGUEZ, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:CARMEN
Authorized Official - Middle Name:
Authorized Official - Last Name:SANTIAGO
Authorized Official - Suffix:
Authorized Official - Credentials:DRPH
Authorized Official - Phone:817-310-1100
Mailing Address - Street 1:580 AVE DE DIEGO
Mailing Address - Street 2:PUERTO NUEVO
Mailing Address - City:SAN JUAN
Mailing Address - State:PR
Mailing Address - Zip Code:00920-3723
Mailing Address - Country:US
Mailing Address - Phone:787-620-5577
Mailing Address - Fax:787-620-5582
Practice Address - Street 1:740 AVE HOSTOS
Practice Address - Street 2:MEDICAL CENTER PLAZA OFFICE 310
Practice Address - City:MAYAGUEZ
Practice Address - State:PR
Practice Address - Zip Code:00682-1539
Practice Address - Country:US
Practice Address - Phone:787-833-1985
Practice Address - Fax:787-831-2262
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-10
Last Update Date:2012-02-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR43153251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR407314Medicare Oscar/Certification