- Enrollment id
- O20050204000797
- Enrollment state
- PR
- Provider type code
- 00-06
- Provider type text
- PART A PROVIDER - HOME HEALTH AGENCY
- Npi
- 1659314664
- Multiple npi flag
- N
- Ccn
- 407008
- Associate id
- 8527972827
- Organization name
- SALUD INTEGRAL EN LA MONTANA INC
- Doing business as name
- SALUD EN EL HOGAR LA MONTANA
- Incorporation date
- 1974-09-01
- Incorporation state
- PR
- Organization type structure
- CORPORATION
- Proprietary nonprofit
- N
- Address line 1
- CARR 164, KM 0.2, SECTOR EL DESVIO
- Address line 2
- BO ACHIOTE
- City
- NARANJTO
- State
- PR
- Zip code
- 00719