Provider Demographics
NPI:1720072986
Name:ST LUKES EPISCOPAL CHURCH HOME CARE PROGRAM
Entity Type:Organization
Organization Name:ST LUKES EPISCOPAL CHURCH HOME CARE PROGRAM
Other - Org Name:ST LUKES HOME HEALTH AGENCY JUANA DIAZ
Other - Org Type:Doing Business As
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:CALLE CARRION MAUDRO ESQ CALLEJON LAS MARIAS
Mailing Address - Street 2:
Mailing Address - City:JUANA DIAZ
Mailing Address - State:PR
Mailing Address - Zip Code:00795
Mailing Address - Country:US
Mailing Address - Phone:787-843-4185
Mailing Address - Fax:787-843-5850
Practice Address - Street 1:CALLE CARRION MAUDRO ESQ CALLEJON LAS MARIAS
Practice Address - Street 2:
Practice Address - City:JUANA DIAZ
Practice Address - State:PR
Practice Address - Zip Code:00795
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:2005-09-02
Last Update Date:2011-12-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR28251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR071002OtherCRUZ AZUL
PA1-9485STOtherTRIPLE S
PR7330102OtherHUMANA
PR9800093OtherACAA
PR7330102OtherHUMANA
PA1-9485STOtherTRIPLE S