Provider Demographics
NPI:1194831750
Name:SERVICIOS DE SALUD EN EL HOGAR LA PROVIDENCIA INC
Entity Type:Organization
Organization Name:SERVICIOS DE SALUD EN EL HOGAR LA PROVIDENCIA INC
Other - Org Name:HOSPICIO LA PROVIDENCIA
Other - Org Type:Doing Business As
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:MS
Authorized Official - First Name:EYLEEN
Authorized Official - Middle Name:I
Authorized Official - Last Name:RODRIGUEZ
Authorized Official - Suffix:
Authorized Official - Credentials:RPT
Authorized Official - Phone:787-843-2364
Mailing Address - Street 1:PO BOX 10447
Mailing Address - Street 2:
Mailing Address - City:PONCE
Mailing Address - State:PR
Mailing Address - Zip Code:00732-0447
Mailing Address - Country:US
Mailing Address - Phone:787-843-2364
Mailing Address - Fax:787-841-2940
Practice Address - Street 1:1206 AVE MUNOZ RIVERA
Practice Address - Street 2:
Practice Address - City:PONCE
Practice Address - State:PR
Practice Address - Zip Code:00717-0639
Practice Address - Country:US
Practice Address - Phone:787-843-2364
Practice Address - Fax:787-841-2940
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-23
Last Update Date:2023-07-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR1251G00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251G00000XAgenciesHospice Care, Community Based
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR40-1500Medicare ID - Type UnspecifiedHOSPICE