1003093121 NPI number — ASOCIACION DE PUERTORRIQUENOS EN MARCHA, INC.

Table of content: (NPI 1003093121)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1003093121 NPI number — ASOCIACION DE PUERTORRIQUENOS EN MARCHA, INC.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
ASOCIACION DE PUERTORRIQUENOS EN MARCHA, INC.
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1003093121
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
12/05/2019
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
4301 RISING SUN AVE
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
PHILADELPHIA
Provider Business Mailing Address State Name:
PA
Provider Business Mailing Address Postal Code:
19140-2719
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
267-296-7220
Provider Business Mailing Address Fax Number:
215-324-1077

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2921 N 5TH ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
PHILADELPHIA
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
19133-2800
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
215-259-3373
Provider Business Practice Location Address Fax Number:
267-329-9728
Provider Enumeration Date:
01/31/2008

Additional Information

Authorized Official

Authorized Official Last Name:
RUIZ
Authorized Official First Name:
NILDA
Authorized Official Middle Name:
Authorized Official Title or Position:
EXECUTIVE DIRECTOR
Authorized Official Telephone Number:
267-296-7200

Provider Taxonomy Codes

  • Taxonomy code: 261QM0801X , with the licence number:  134920 , registered in the state of PA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 261QM0801X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 1003114240021 , issued by the state of ( PA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 1003093121 , issued by the state of ( PA ) . This identifiers is of the category "MEDICAID".




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