Provider Demographics
NPI:1306846878
Name:CARIBBEAN HOSPICE CORPORATION
Entity Type:Organization
Organization Name:CARIBBEAN HOSPICE CORPORATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:AMNERIS
Authorized Official - Middle Name:OMS
Authorized Official - Last Name:SANDOVAL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:787-764-6555
Mailing Address - Street 1:WINSTON CHURCHILL AVENUE
Mailing Address - Street 2:#153 CROWN HILLS
Mailing Address - City:SAN JUAN
Mailing Address - State:PR
Mailing Address - Zip Code:00926-6012
Mailing Address - Country:US
Mailing Address - Phone:787-764-6555
Mailing Address - Fax:787-758-3035
Practice Address - Street 1:WINSTON CHURCHILL AVENUE
Practice Address - Street 2:#153 CROWN HILLS
Practice Address - City:SAN JUAN
Practice Address - State:PR
Practice Address - Zip Code:00926-6012
Practice Address - Country:US
Practice Address - Phone:787-764-6555
Practice Address - Fax:787-758-3035
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-07-27
Last Update Date:2014-01-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR04-079251G00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251G00000XAgenciesHospice Care, Community Based
Provider Identifiers
StateIdentifier IDID TypeIssuer
1-9943OtherTRIPLE S INC
401503Medicare ID - Type Unspecified