Provider Demographics
NPI:1275541500
Name:JERUSALEN HOME AMBULANCE, INC.
Entity Type:Organization
Organization Name:JERUSALEN HOME AMBULANCE, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:LUIS
Authorized Official - Middle Name:
Authorized Official - Last Name:ORTIZ
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:787-653-2225
Mailing Address - Street 1:PO BOX 1780
Mailing Address - Street 2:
Mailing Address - City:CAGUAS
Mailing Address - State:PR
Mailing Address - Zip Code:00726-1780
Mailing Address - Country:US
Mailing Address - Phone:787-653-2225
Mailing Address - Fax:787-653-1720
Practice Address - Street 1:AVE LUIS MUNOZ MARIN ESQUINA GEORGETTI
Practice Address - Street 2:ANGORA PARK PLAZA
Practice Address - City:CAGUAS
Practice Address - State:PR
Practice Address - Zip Code:00725
Practice Address - Country:US
Practice Address - Phone:787-653-1717
Practice Address - Fax:787-653-1720
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-03
Last Update Date:2014-02-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PRTCAMB-3613416L0300X
PRTCAMB-1643416L0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3416L0300XTransportation ServicesAmbulanceLand Transport
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR0059338Medicare ID - Type UnspecifiedPROVIDER NUMBER