Provider Demographics
NPI:1043324874
Name:SERVICIOS SUPLEMENTARIOS DE SALUD, INC.
Entity type:Organization
Organization Name:SERVICIOS SUPLEMENTARIOS DE SALUD, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:CARMEN
Authorized Official - Middle Name:M
Authorized Official - Last Name:MARTINO
Authorized Official - Suffix:
Authorized Official - Credentials:RN MSN
Authorized Official - Phone:787-753-8095
Mailing Address - Street 1:114 ELEANOR ROOSEVELT ST.
Mailing Address - Street 2:URB. EL VEDADO
Mailing Address - City:HATO REY
Mailing Address - State:PR
Mailing Address - Zip Code:00918
Mailing Address - Country:US
Mailing Address - Phone:787-759-7035
Mailing Address - Fax:787-759-7303
Practice Address - Street 1:114 ELEANOR ROOSEVELT ST.
Practice Address - Street 2:URB. EL VEDADO
Practice Address - City:HATO REY
Practice Address - State:PR
Practice Address - Zip Code:00918
Practice Address - Country:US
Practice Address - Phone:787-780-4010
Practice Address - Fax:787-787-5787
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-18
Last Update Date:2008-10-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR12251G00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251G00000XAgenciesHospice Care, Community Based
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR401529Medicare Oscar/Certification
PR401529Medicare PIN