Provider Demographics
NPI:1851377592
Name:CAMINO DE LUZ HOSPICE CARE INC
Entity Type:Organization
Organization Name:CAMINO DE LUZ HOSPICE CARE INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR EJECUTIVO
Authorized Official - Prefix:
Authorized Official - First Name:MANUEL
Authorized Official - Middle Name:SANTIAGO
Authorized Official - Last Name:CONCEPCION
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:787-884-0786
Mailing Address - Street 1:PO BOX 3446
Mailing Address - Street 2:
Mailing Address - City:MANATI
Mailing Address - State:PR
Mailing Address - Zip Code:00674-3446
Mailing Address - Country:US
Mailing Address - Phone:787-884-4668
Mailing Address - Fax:787-884-4668
Practice Address - Street 1:BARRIADA FELIX CORDABA DAVILA #13
Practice Address - Street 2:
Practice Address - City:MANATI
Practice Address - State:PR
Practice Address - Zip Code:00674
Practice Address - Country:US
Practice Address - Phone:787-884-0786
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-12-15
Last Update Date:2008-02-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251G00000XAgenciesHospice Care, Community Based
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR401558Medicare Oscar/Certification