Provider Demographics
NPI:1932108776
Name:ST LUKES EPISCOPAL CHURCH HOME CARE PROGRAM
Entity Type:Organization
Organization Name:ST LUKES EPISCOPAL CHURCH HOME CARE PROGRAM
Other - Org Name:HOSPICIO SAN LUCAS
Other - Org Type:Other Name
Authorized Official - Title/Position:OPERATIONAL EXECUTIVE DIRECTOR
Authorized Official - Prefix:MS
Authorized Official - First Name:ISUANET
Authorized Official - Middle Name:
Authorized Official - Last Name:CASTILLO
Authorized Official - Suffix:
Authorized Official - Credentials:CPA
Authorized Official - Phone:787-843-4185
Mailing Address - Street 1:PO BOX 7064
Mailing Address - Street 2:
Mailing Address - City:PONCE
Mailing Address - State:PR
Mailing Address - Zip Code:00732-7064
Mailing Address - Country:US
Mailing Address - Phone:787-843-4185
Mailing Address - Fax:787-843-5850
Practice Address - Street 1:917 AVE TITO CASTRO
Practice Address - Street 2:EDIFICIO A PISO 4
Practice Address - City:PONCE
Practice Address - State:PR
Practice Address - Zip Code:00716-4717
Practice Address - Country:US
Practice Address - Phone:787-843-4185
Practice Address - Fax:787-843-5850
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-07-14
Last Update Date:2011-12-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR13251G00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251G00000XAgenciesHospice Care, Community Based
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR7320125OtherHUMANA
PR19485OtherTRIPLE S
PR7320125OtherHUMANA
PR=========OtherCIGNA
PR=========OtherSALUD
PR=========OtherMCS
PR401530Medicare ID - Type UnspecifiedHOSPICIO