Provider Demographics
NPI:1225435324
Name:HOSPICIO LA MONSERRATE
Entity Type:Organization
Organization Name:HOSPICIO LA MONSERRATE
Other - Org Name:HOSPICIO LA MONSERRATE
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:SECRETARY
Authorized Official - Prefix:MRS
Authorized Official - First Name:MAYRA
Authorized Official - Middle Name:R
Authorized Official - Last Name:MENDEZ
Authorized Official - Suffix:
Authorized Official - Credentials:MA BUSSINESS ADM
Authorized Official - Phone:787-873-5999
Mailing Address - Street 1:PO BOX 1263
Mailing Address - Street 2:
Mailing Address - City:AGUADA
Mailing Address - State:PR
Mailing Address - Zip Code:00602-1263
Mailing Address - Country:US
Mailing Address - Phone:787-873-5998
Mailing Address - Fax:787-873-6001
Practice Address - Street 1:14 AVE QUILINCHINI
Practice Address - Street 2:1
Practice Address - City:SABANA GRANDE
Practice Address - State:PR
Practice Address - Zip Code:00637-0000
Practice Address - Country:US
Practice Address - Phone:787-873-5998
Practice Address - Fax:787-873-6001
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-12-04
Last Update Date:2016-10-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR13-016251G00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251G00000XAgenciesHospice Care, Community Based
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR48OtherLICENCIA DEL ESTADO
PR401573OtherCMS CERTIFICATIONS
PR568042OtherJOINT COMMISSION CERTIFICATION