Provider Demographics
NPI:1639113301
Name:WESTERN MEDICAL HOSPICE, INC.
Entity Type:Organization
Organization Name:WESTERN MEDICAL HOSPICE, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:LUIS
Authorized Official - Middle Name:HORACIO
Authorized Official - Last Name:RUIZ
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:787-833-5898
Mailing Address - Street 1:PO BOX 8174
Mailing Address - Street 2:MARINA STATION
Mailing Address - City:MAYAGUEZ
Mailing Address - State:PR
Mailing Address - Zip Code:00681-8174
Mailing Address - Country:US
Mailing Address - Phone:787-833-5898
Mailing Address - Fax:787-832-3795
Practice Address - Street 1:#4040 CALLE B LOTE 30
Practice Address - Street 2:ZONA INDUSTRIAL GUANAJIBO, SUITE 4,
Practice Address - City:MAYAGUEZ
Practice Address - State:PR
Practice Address - Zip Code:00682-1378
Practice Address - Country:US
Practice Address - Phone:787-831-2252
Practice Address - Fax:787-834-6220
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-15
Last Update Date:2014-08-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251G00000XAgenciesHospice Care, Community Based
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR401561Medicare Oscar/Certification