Provider Demographics
NPI:1437297223
Name:SANTIAGO, INC.
Entity Type:Organization
Organization Name:SANTIAGO, INC.
Other - Org Name:FIRSTAT NURSING SERVICES
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:JAIME
Authorized Official - Middle Name:G
Authorized Official - Last Name:VILLABLANCA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:561-684-9000
Mailing Address - Street 1:5601 CORPORATE WAY
Mailing Address - Street 2:SUITE 404
Mailing Address - City:WEST PALM BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33407-2025
Mailing Address - Country:US
Mailing Address - Phone:561-684-9000
Mailing Address - Fax:561-684-3391
Practice Address - Street 1:3201 W COMMERCIAL BLVD
Practice Address - Street 2:SUITE 114
Practice Address - City:FORT LAUDERDALE
Practice Address - State:FL
Practice Address - Zip Code:33309-3440
Practice Address - Country:US
Practice Address - Phone:954-731-0070
Practice Address - Fax:954-731-7871
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-02
Last Update Date:2008-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL21394096251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL108092Medicare ID - Type UnspecifiedMEDICARE PROVIDER NUMBER