Basic Information
| Provider Information | |||||||||
| NPI: | 1295837524 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | ESTANCIA HOMECARE, INC. | ||||||||
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| Mailing Information | |||||||||
| Address1: | VIA MIRTA 3KS5 | ||||||||
| Address2: | VILLA FONTANA | ||||||||
| City: | CAROLINA | ||||||||
| State: | PR | ||||||||
| PostalCode: | 009834639 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7877620889 | ||||||||
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| Practice Location | |||||||||
| Address1: | VIA MIRTA 3KS5 | ||||||||
| Address2: | VILLA FONTANA | ||||||||
| City: | CAROLINA | ||||||||
| State: | PR | ||||||||
| PostalCode: | 009834639 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7877620889 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 09/05/2006 | ||||||||
| LastUpdateDate: | 09/12/2007 | ||||||||
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| AuthorizedOfficialLastName: | CRUZ | ||||||||
| AuthorizedOfficialFirstName: | MILTON | ||||||||
| AuthorizedOfficialMiddleName: | |||||||||
| AuthorizedOfficialTitleorPosition: | PRESIDENT | ||||||||
| AuthorizedOfficialTelephone: | 7877065255 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | MR. | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 251E00000X | 08B3316 | PR | Y | Agencies | Home Health |
No ID Information.