Provider Demographics
NPI:1780003327
Name:HOME MEDIC COORDINATION
Entity Type:Organization
Organization Name:HOME MEDIC COORDINATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENTE
Authorized Official - Prefix:MR
Authorized Official - First Name:CARLOS
Authorized Official - Middle Name:
Authorized Official - Last Name:LEON
Authorized Official - Suffix:III
Authorized Official - Credentials:
Authorized Official - Phone:787-388-0800
Mailing Address - Street 1:#91 CALLE LUIS MUNOZ RIVERA
Mailing Address - Street 2:
Mailing Address - City:SANTA ISABEL
Mailing Address - State:PR
Mailing Address - Zip Code:00757
Mailing Address - Country:US
Mailing Address - Phone:787-845-1188
Mailing Address - Fax:
Practice Address - Street 1:91 CALLE LUIS MUNOZ RIVERA
Practice Address - Street 2:
Practice Address - City:SANTA ISABEL
Practice Address - State:PR
Practice Address - Zip Code:00757-2659
Practice Address - Country:US
Practice Address - Phone:787-845-1188
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-04-10
Last Update Date:2014-04-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR162230261QM0801X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR0085218Medicare PIN