He was appointed bishop of San Francisco de Macorís on 16 January 1978 by Pope Paul VI and was consecrated on 25 February 1978 by Cardinal Octavio Antonio Beras Rojas, archbishop of Santo Domingo, assisted by Juan Antonio Flores Santana, bishop of La Vega, and by Jesús María De Jesús Moya, auxiliary of Santiago de los Caballeros. He served as rector of the University of San Francisco de Macorís from 1979 to 1984. He was promoted to the metropolitan and primatial see of Santo Domingo on 15 November 1981. He was elected president of the Conference of the Dominican Episcopate in July 1984 and served as President of the Latin American Episcopal Council from 25 April 1991 to 1994. He was created Cardinal and assigned the titular church of San Pio X alla Balduina in the consistory of 28 June 1991.