Provider Demographics
NPI:1932678992
Name:FIRST HEALTH HOME CARE BENEFIT
Entity Type:Organization
Organization Name:FIRST HEALTH HOME CARE BENEFIT
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:ENRIQUE
Authorized Official - Middle Name:J
Authorized Official - Last Name:ILLAS
Authorized Official - Suffix:
Authorized Official - Credentials:RN
Authorized Official - Phone:939-529-1320
Mailing Address - Street 1:URB PUERTO NUEVO CALLE ARAGON
Mailing Address - Street 2:BUZON 605
Mailing Address - City:SAN JUAN
Mailing Address - State:PR
Mailing Address - Zip Code:00920
Mailing Address - Country:US
Mailing Address - Phone:939-529-1320
Mailing Address - Fax:
Practice Address - Street 1:URB PUERTO NUEVO CALLE ARAGON
Practice Address - Street 2:605
Practice Address - City:SAN JUAN
Practice Address - State:PR
Practice Address - Zip Code:00920
Practice Address - Country:US
Practice Address - Phone:787-749-2727
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-11-20
Last Update Date:2018-11-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes163WH0200XNursing Service ProvidersRegistered NurseHome HealthGroup - Multi-Specialty
No251J00000XAgenciesNursing CareGroup - Multi-Specialty