Provider Demographics
NPI:1295837524
Name:ESTANCIA HOMECARE, INC.
Entity Type:Organization
Organization Name:ESTANCIA HOMECARE, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:MILTON
Authorized Official - Middle Name:
Authorized Official - Last Name:CRUZ
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:787-706-5255
Mailing Address - Street 1:VIA MIRTA 3KS5
Mailing Address - Street 2:VILLA FONTANA
Mailing Address - City:CAROLINA
Mailing Address - State:PR
Mailing Address - Zip Code:00983-4639
Mailing Address - Country:US
Mailing Address - Phone:787-762-0889
Mailing Address - Fax:
Practice Address - Street 1:VIA MIRTA 3KS5
Practice Address - Street 2:VILLA FONTANA
Practice Address - City:CAROLINA
Practice Address - State:PR
Practice Address - Zip Code:00983-4639
Practice Address - Country:US
Practice Address - Phone:787-762-0889
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-05
Last Update Date:2007-09-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR08B3316251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR407032Medicare PIN