Provider Demographics
NPI:1427036342
Name:MENNONITE GENERAL HOSPITAL, INC.
Entity Type:Organization
Organization Name:MENNONITE GENERAL HOSPITAL, INC.
Other - Org Name:HOSPICIO MENONITA
Other - Org Type:Doing Business As
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:ANA
Authorized Official - Middle Name:B
Authorized Official - Last Name:TORRES
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:787-743-1121
Mailing Address - Street 1:PO BOX 5742
Mailing Address - Street 2:
Mailing Address - City:CAGUAS
Mailing Address - State:PR
Mailing Address - Zip Code:00726
Mailing Address - Country:US
Mailing Address - Phone:787-258-1628
Mailing Address - Fax:787-746-1066
Practice Address - Street 1:CARR #1 KM 34 9 BO BAIROA
Practice Address - Street 2:
Practice Address - City:CAGUAS
Practice Address - State:PR
Practice Address - Zip Code:00725
Practice Address - Country:US
Practice Address - Phone:787-258-1628
Practice Address - Fax:787-746-1066
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-01-03
Last Update Date:2017-10-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR04118251G00000X
PRLIC.#5CNC#15-102251G00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251G00000XAgenciesHospice Care, Community Based
Provider Identifiers
StateIdentifier IDID TypeIssuer
401510Medicare ID - Type Unspecified