Provider Demographics
NPI:1629002316
Name:SERVICIOS DE SALUD EN EL HOGAR EL GIGANTE, INC.
Entity Type:Organization
Organization Name:SERVICIOS DE SALUD EN EL HOGAR EL GIGANTE, INC.
Other - Org Name:CUIDADO CASERO EL GIGANTE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:CARMEN
Authorized Official - Middle Name:
Authorized Official - Last Name:SANTIAGO
Authorized Official - Suffix:
Authorized Official - Credentials:DRPH
Authorized Official - Phone:817-310-1100
Mailing Address - Street 1:580 AVE DE DIEGO
Mailing Address - Street 2:PUERTO NUEVO
Mailing Address - City:SAN JUAN
Mailing Address - State:PR
Mailing Address - Zip Code:00920-3723
Mailing Address - Country:US
Mailing Address - Phone:787-620-5577
Mailing Address - Fax:787-620-5582
Practice Address - Street 1:66 CALLE RODULFO GONZALEZ
Practice Address - Street 2:APARTADO 117
Practice Address - City:ADJUNTAS
Practice Address - State:PR
Practice Address - Zip Code:00601-2150
Practice Address - Country:US
Practice Address - Phone:787-829-7710
Practice Address - Fax:787-829-4453
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-10
Last Update Date:2012-02-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR17810251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR407024Medicare Oscar/Certification