Provider Demographics
NPI:1790871333
Name:HOSPICIO SANTA RITA, INC.
Entity Type:Organization
Organization Name:HOSPICIO SANTA RITA, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:LICEDIA
Authorized Official - Middle Name:
Authorized Official - Last Name:ROSADO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:787-589-0003
Mailing Address - Street 1:PO BOX 1143
Mailing Address - Street 2:
Mailing Address - City:AGUADA
Mailing Address - State:PR
Mailing Address - Zip Code:00602-0602
Mailing Address - Country:US
Mailing Address - Phone:787-589-0003
Mailing Address - Fax:787-589-0006
Practice Address - Street 1:CARR 417 KM 0.7 AVE ROTARIO
Practice Address - Street 2:
Practice Address - City:AGUADA
Practice Address - State:PR
Practice Address - Zip Code:00602-0602
Practice Address - Country:US
Practice Address - Phone:787-589-0003
Practice Address - Fax:787-589-0006
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-04
Last Update Date:2008-09-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR251G00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251G00000XAgenciesHospice Care, Community Based
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR40-1533Medicare ID - Type UnspecifiedSANTA RITA HOSPICE