Provider Demographics
NPI:1982722807
Name:METROHEALTH EXTENDED CARE, INC
Entity Type:Organization
Organization Name:METROHEALTH EXTENDED CARE, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MISS
Authorized Official - First Name:MARIA
Authorized Official - Middle Name:
Authorized Official - Last Name:DIAZ
Authorized Official - Suffix:
Authorized Official - Credentials:MHSA
Authorized Official - Phone:787-889-4001
Mailing Address - Street 1:PO BOX 191625
Mailing Address - Street 2:
Mailing Address - City:SAN JUAN
Mailing Address - State:PR
Mailing Address - Zip Code:00919-1625
Mailing Address - Country:US
Mailing Address - Phone:787-889-4001
Mailing Address - Fax:787-889-4575
Practice Address - Street 1:PR 3 KM 32.0
Practice Address - Street 2:BO MAMEYES INTERIOR
Practice Address - City:LUQUILLO
Practice Address - State:PR
Practice Address - Zip Code:00773
Practice Address - Country:US
Practice Address - Phone:787-889-4001
Practice Address - Fax:787-889-4575
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-27
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR7314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility