Provider Demographics
NPI:1508865312
Name:ST LUKES EPISCOPAL CHURCH HOME CARE PROGRAM
Entity Type:Organization
Organization Name:ST LUKES EPISCOPAL CHURCH HOME CARE PROGRAM
Other - Org Name:SAINT LUKES HOME HEALTH AGENCY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OPERATIONAL EXECUTIVE DIRECTOR
Authorized Official - Prefix:MS
Authorized Official - First Name:ISUANET
Authorized Official - Middle Name:
Authorized Official - Last Name:CASTILLO
Authorized Official - Suffix:
Authorized Official - Credentials:CPA
Authorized Official - Phone:787-843-4185
Mailing Address - Street 1:RR1 BOX 6091
Mailing Address - Street 2:
Mailing Address - City:GUAYAMA
Mailing Address - State:PR
Mailing Address - Zip Code:00784-9601
Mailing Address - Country:US
Mailing Address - Phone:787-843-4185
Mailing Address - Fax:787-843-5850
Practice Address - Street 1:CENTRO COMERCIAL SAN VICENTE MALL
Practice Address - Street 2:SECTOR MELANIA CARR #3
Practice Address - City:GUAYAMA
Practice Address - State:PR
Practice Address - Zip Code:00784-9601
Practice Address - Country:US
Practice Address - Phone:787-843-4185
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-07-14
Last Update Date:2011-12-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR25251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR1-9485STOtherTRIPLE S
PR9800093OtherACAA
PR071002OtherCRUZ AZUL
PR7330102OtherHUMANA
PR1-9485STOtherTRIPLE S
PR9800093OtherACAA