Provider Demographics
NPI:1780765974
Name:EXTEDND CARE PULMONARY REHAB
Entity type:Organization
Organization Name:EXTEDND CARE PULMONARY REHAB
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:RICHARD
Authorized Official - Middle Name:THOMAS
Authorized Official - Last Name:ESCOBAR
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:1352-898-1543
Mailing Address - Street 1:CALLE EMILIO RUIZ #21
Mailing Address - Street 2:
Mailing Address - City:SAN SEBASTIAN
Mailing Address - State:PR
Mailing Address - Zip Code:00685
Mailing Address - Country:US
Mailing Address - Phone:787-896-1510
Mailing Address - Fax:787-896-1605
Practice Address - Street 1:CALLE EMILIO RUIZ #21
Practice Address - Street 2:
Practice Address - City:SAN SEBASTIAN
Practice Address - State:PR
Practice Address - Zip Code:00685
Practice Address - Country:US
Practice Address - Phone:787-896-1510
Practice Address - Fax:787-896-1605
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-17
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR1000970001Medicare ID - Type UnspecifiedDURABLE MEDICAL EQUIPMENT