Provider Demographics
NPI:1881814044
Name:GOLDEN CROSS HEALTH PLAN CORP.
Entity type:Organization
Organization Name:GOLDEN CROSS HEALTH PLAN CORP.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTORA DE FINANZAS
Authorized Official - Prefix:MRS
Authorized Official - First Name:VILMA
Authorized Official - Middle Name:L
Authorized Official - Last Name:ROSADO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:787-721-0427
Mailing Address - Street 1:P.O. BOX 12330
Mailing Address - Street 2:
Mailing Address - City:SAN JUAN
Mailing Address - State:PR
Mailing Address - Zip Code:00914-2330
Mailing Address - Country:US
Mailing Address - Phone:787-721-0427
Mailing Address - Fax:
Practice Address - Street 1:150 AVE DE DIEGO
Practice Address - Street 2:SUITE 504
Practice Address - City:SANTURCE
Practice Address - State:PR
Practice Address - Zip Code:00907-2300
Practice Address - Country:US
Practice Address - Phone:787-721-0427
Practice Address - Fax:787-721-5464
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-27
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR55785302R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes302R00000XManaged Care OrganizationsHealth Maintenance Organization
Provider Identifiers
StateIdentifier IDID TypeIssuer
PRCMS-H9984Medicare ID - Type UnspecifiedMEDICARE ADVANTAGE PLAN