Provider Demographics
NPI:1235635731
Name:HOSPICIO KRYSTAL INC
Entity Type:Organization
Organization Name:HOSPICIO KRYSTAL INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MRS
Authorized Official - First Name:GLORIA
Authorized Official - Middle Name:DEL C
Authorized Official - Last Name:AMADOR FERNANDEZ
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:787-869-5900
Mailing Address - Street 1:PO BOX 515
Mailing Address - Street 2:
Mailing Address - City:NARANJITO
Mailing Address - State:PR
Mailing Address - Zip Code:00719-0515
Mailing Address - Country:US
Mailing Address - Phone:787-869-5900
Mailing Address - Fax:
Practice Address - Street 1:155 CALLE RAMOS ANTONINI E
Practice Address - Street 2:
Practice Address - City:MAYAGUEZ
Practice Address - State:PR
Practice Address - Zip Code:00680-5043
Practice Address - Country:US
Practice Address - Phone:787-805-6325
Practice Address - Fax:787-805-6301
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-04-03
Last Update Date:2022-04-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR251G00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251G00000XAgenciesHospice Care, Community Based