Provider Demographics
NPI:1295000347
Name:SAN JUAN AGING CENTER
Entity Type:Organization
Organization Name:SAN JUAN AGING CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SUP. DEP DE FACTURACION
Authorized Official - Prefix:DR
Authorized Official - First Name:JOSEFA
Authorized Official - Middle Name:
Authorized Official - Last Name:COTTO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:787-480-3876
Mailing Address - Street 1:1187 CALLE 46 SE
Mailing Address - Street 2:REPARTO METROPOLITANO
Mailing Address - City:SAN JUAN
Mailing Address - State:PR
Mailing Address - Zip Code:00921-2625
Mailing Address - Country:US
Mailing Address - Phone:787-480-5402
Mailing Address - Fax:787-649-9904
Practice Address - Street 1:1187 CALLE 46 SE
Practice Address - Street 2:URBANIZACION REPARTO METROPOLITANO
Practice Address - City:SAN JUAN
Practice Address - State:PR
Practice Address - Zip Code:00921-2625
Practice Address - Country:US
Practice Address - Phone:787-480-5402
Practice Address - Fax:787-764-9904
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-03-21
Last Update Date:2012-03-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR25487311ZA0620X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes311ZA0620XNursing & Custodial Care FacilitiesCustodial Care FacilityAdult Care Home
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR25487OtherNURSE LICENSE