Provider Demographics
NPI:1982660882
Name:LA CASA DEL CONVALECIENTE, INC.
Entity Type:Organization
Organization Name:LA CASA DEL CONVALECIENTE, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MRS
Authorized Official - First Name:MARIJULIA
Authorized Official - Middle Name:
Authorized Official - Last Name:RODRIGUEZ
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:787-774-0800
Mailing Address - Street 1:PO BOX 79218
Mailing Address - Street 2:
Mailing Address - City:CAROLINA
Mailing Address - State:PR
Mailing Address - Zip Code:00984-9218
Mailing Address - Country:US
Mailing Address - Phone:787-774-0800
Mailing Address - Fax:787-774-0814
Practice Address - Street 1:917 CALLE TRINITY STE 6
Practice Address - Street 2:EL COMANDANTE IND. PARK
Practice Address - City:CAROLINA
Practice Address - State:PR
Practice Address - Zip Code:00982-3413
Practice Address - Country:US
Practice Address - Phone:787-774-0800
Practice Address - Fax:787-774-0814
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-04-21
Last Update Date:2013-10-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR05062209SJ332BX2000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332BX2000XSuppliersDurable Medical Equipment & Medical SuppliesOxygen Equipment & Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR5759340001Medicare NSC