Provider Demographics
NPI:1205870086
Name:SALUD INTEGRAL EN LA MONTANA, INC
Entity type:Organization
Organization Name:SALUD INTEGRAL EN LA MONTANA, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:GLORIA
Authorized Official - Middle Name:DEL C
Authorized Official - Last Name:AMADOR FERNANDEZ
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:787-869-5900
Mailing Address - Street 1:PO BOX 515
Mailing Address - Street 2:
Mailing Address - City:NARANJITO
Mailing Address - State:PR
Mailing Address - Zip Code:00719-0515
Mailing Address - Country:US
Mailing Address - Phone:787-869-5900
Mailing Address - Fax:787-857-4482
Practice Address - Street 1:CARR 152 KM 12.2
Practice Address - Street 2:BO CEDRO ARRIBA
Practice Address - City:NARANJITO
Practice Address - State:PR
Practice Address - Zip Code:00719-0515
Practice Address - Country:US
Practice Address - Phone:787-857-5800
Practice Address - Fax:787-857-4482
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:SALUD INTEGRAL EN LA MONTANA, INC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2006-06-15
Last Update Date:2018-09-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR4251G00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251G00000XAgenciesHospice Care, Community Based
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR40-1509Medicare ID - Type UnspecifiedHOSPICE AGENCY