Provider Demographics
NPI:1275726028
Name:HUMACAOHOMECARE
Entity Type:Organization
Organization Name:HUMACAOHOMECARE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:GABRIEL
Authorized Official - Middle Name:
Authorized Official - Last Name:SANTIAGO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:787-285-4555
Mailing Address - Street 1:AVENIDA FONT MARTELO
Mailing Address - Street 2:301
Mailing Address - City:HUMACAO
Mailing Address - State:PR
Mailing Address - Zip Code:00791-3204
Mailing Address - Country:US
Mailing Address - Phone:787-285-0487
Mailing Address - Fax:787-285-4555
Practice Address - Street 1:AVENIDA FONT MARTELO
Practice Address - Street 2:301
Practice Address - City:HUMACAO
Practice Address - State:PR
Practice Address - Zip Code:00791-0000
Practice Address - Country:US
Practice Address - Phone:787-285-0487
Practice Address - Fax:787-285-4555
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-08-24
Last Update Date:2007-08-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR134311ZA0620X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes311ZA0620XNursing & Custodial Care FacilitiesCustodial Care FacilityAdult Care Home