Provider Demographics
NPI:1669402632
Name:FOUNDACION DR MANUEL DE LA PILA IGELSIAS
Entity type:Organization
Organization Name:FOUNDACION DR MANUEL DE LA PILA IGELSIAS
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT GOVERNMENT BODY
Authorized Official - Prefix:MR
Authorized Official - First Name:HUMBERTO
Authorized Official - Middle Name:
Authorized Official - Last Name:LABOY
Authorized Official - Suffix:
Authorized Official - Credentials:CPA
Authorized Official - Phone:787-848-4617
Mailing Address - Street 1:2413 AVE LAS AMERICAS
Mailing Address - Street 2:HOSP ITAL DR. PILA HOME HEALTH PROGRAM
Mailing Address - City:PONCE
Mailing Address - State:PR
Mailing Address - Zip Code:00717-2113
Mailing Address - Country:US
Mailing Address - Phone:787-848-6980
Mailing Address - Fax:787-844-8280
Practice Address - Street 1:2413 AVE LAS AMERICAS
Practice Address - Street 2:HOSP ITAL DR. PILA HOME HEALTH PROGRAM
Practice Address - City:PONCE
Practice Address - State:PR
Practice Address - Zip Code:00717-2113
Practice Address - Country:US
Practice Address - Phone:787-848-6980
Practice Address - Fax:787-844-8280
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-04
Last Update Date:2008-06-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR80664251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR407003Medicare ID - Type Unspecified