Provider Demographics
NPI:1730586751
Name:GRACE HOSPICE OF PUERTO RICO, LLC
Entity type:Organization
Organization Name:GRACE HOSPICE OF PUERTO RICO, LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PARTNER
Authorized Official - Prefix:MR
Authorized Official - First Name:PAT
Authorized Official - Middle Name:
Authorized Official - Last Name:TAGGART
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:787-222-4842
Mailing Address - Street 1:PO BOX 366403
Mailing Address - Street 2:
Mailing Address - City:SAN JUAN
Mailing Address - State:PR
Mailing Address - Zip Code:00936-6403
Mailing Address - Country:US
Mailing Address - Phone:787-946-1078
Mailing Address - Fax:787-946-1097
Practice Address - Street 1:AVE. MUNOZ RIVERA #500
Practice Address - Street 2:CONDOMINIO EL CENTRO SUITE #6
Practice Address - City:SAN JUAN
Practice Address - State:PR
Practice Address - Zip Code:00918-0000
Practice Address - Country:US
Practice Address - Phone:787-946-1078
Practice Address - Fax:787-946-1097
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-11-20
Last Update Date:2017-06-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR23 CNC NUM. 12-209251G00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251G00000XAgenciesHospice Care, Community Based