Provider Demographics
NPI:1922321488
Name:CHANGRI-LA RESORT, INC.
Entity Type:Organization
Organization Name:CHANGRI-LA RESORT, INC.
Other - Org Name:DBA CARIBBEAN PARADISE CONVALESCENT
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MRS
Authorized Official - First Name:CARMEN
Authorized Official - Middle Name:L
Authorized Official - Last Name:RODRIGUEZ-DIAZ
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:787-839-5885
Mailing Address - Street 1:ROAD # 3 KM 114.3 BARRIO GUARDARRAYA
Mailing Address - Street 2:PO BOX 1092
Mailing Address - City:PATILLAS
Mailing Address - State:PR
Mailing Address - Zip Code:00723
Mailing Address - Country:US
Mailing Address - Phone:787-839-7388
Mailing Address - Fax:787-271-0069
Practice Address - Street 1:ROAD 3 KM 114 HM 3
Practice Address - Street 2:BARRIO GUARDARRAYA
Practice Address - City:PATILLAS
Practice Address - State:PR
Practice Address - Zip Code:00723
Practice Address - Country:US
Practice Address - Phone:787-839-7388
Practice Address - Fax:787-271-0069
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-03-11
Last Update Date:2010-03-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility