Provider Demographics
NPI:1952387524
Name:PRESBYTERIAN RESP CARE SERV
Entity Type:Organization
Organization Name:PRESBYTERIAN RESP CARE SERV
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATIVE PARTNER
Authorized Official - Prefix:DR
Authorized Official - First Name:BELISARIO
Authorized Official - Middle Name:
Authorized Official - Last Name:MATTA DE JUAN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:787-725-7860
Mailing Address - Street 1:PMB 423 1357 ASHFORD AVE
Mailing Address - Street 2:SUITE 2
Mailing Address - City:SAN JUAN
Mailing Address - State:PR
Mailing Address - Zip Code:00907-1420
Mailing Address - Country:US
Mailing Address - Phone:787-725-7860
Mailing Address - Fax:787-722-3630
Practice Address - Street 1:1451 ASHFORD
Practice Address - Street 2:2ND FLOOR
Practice Address - City:SAN JUAN
Practice Address - State:PR
Practice Address - Zip Code:00907-1511
Practice Address - Country:US
Practice Address - Phone:787-725-7860
Practice Address - Fax:787-722-3630
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-12-15
Last Update Date:2008-06-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR4154385H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes385H00000XRespite Care FacilityRespite Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
PRD48287Medicare UPIN