Provider Demographics
NPI:1588658132
Name:SERVICIOS DE SALUD EN EL HOGAR EL NAZARENO INC
Entity Type:Organization
Organization Name:SERVICIOS DE SALUD EN EL HOGAR EL NAZARENO INC
Other - Org Name:NAZARENO HOME CARE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:MS
Authorized Official - First Name:EMERITA
Authorized Official - Middle Name:
Authorized Official - Last Name:VAZQUEZ LOPEZ
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:787-633-5353
Mailing Address - Street 1:P.O. BOX 553
Mailing Address - Street 2:
Mailing Address - City:LUQUILLO
Mailing Address - State:PR
Mailing Address - Zip Code:00773-0553
Mailing Address - Country:US
Mailing Address - Phone:787-655-5353
Mailing Address - Fax:787-655-5357
Practice Address - Street 1:C2 SOLAR #1
Practice Address - Street 2:URB. BRISAS DEL MAR
Practice Address - City:LUQUILLO
Practice Address - State:PR
Practice Address - Zip Code:00773-0000
Practice Address - Country:US
Practice Address - Phone:787-655-5353
Practice Address - Fax:787-655-5357
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-09-09
Last Update Date:2018-11-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR11251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR40-7012Medicare ID - Type UnspecifiedPROVIDER NO.