1598750192 NPI number — ADMINISTRACION DE SERVICIOS DE SALUD MENTAL Y CONTRA LA ADICCION

Table of content: (NPI 1598750192)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1598750192 NPI number — ADMINISTRACION DE SERVICIOS DE SALUD MENTAL Y CONTRA LA ADICCION

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
ADMINISTRACION DE SERVICIOS DE SALUD MENTAL Y CONTRA LA ADICCION
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:
HOSPITAL PSIQUIATRICO DR. RAMON FERNANDEZ MARINA
Provider Other Organization Name Type Code:
3
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:
1598750192
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
12/05/2018
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 2100
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
SAN JUAN
Provider Business Mailing Address State Name:
PR
Provider Business Mailing Address Postal Code:
00922-2100
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
787-766-4646
Provider Business Mailing Address Fax Number:
787-763-2344

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
COND MAGA
Provider Second Line Business Practice Location Address:
BO MONACILLOS CENTRO MEDICO
Provider Business Practice Location Address City Name:
SAN JUAN
Provider Business Practice Location Address State Name:
PR
Provider Business Practice Location Address Postal Code:
00907-1966
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
787-766-4646
Provider Business Practice Location Address Fax Number:
787-763-2344
Provider Enumeration Date:
09/20/2005

Additional Information

Authorized Official

Authorized Official Last Name:
BAEZ SALGADO
Authorized Official First Name:
JIMMY
Authorized Official Middle Name:
Authorized Official Title or Position:
MANAGER
Authorized Official Telephone Number:
787-763-7575

Provider Taxonomy Codes

  • Taxonomy code: 283Q00000X , with the licence number:  9 , registered in the state of PR ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 45-9138 , issued by the state of ( PR ) . This identifiers is of the category "MEDICAID".
  • Identifier: 482 , issued by the state of ( PR ) . This identifiers is of the category "MEDICAID".
  • Identifier: H-0260 , issued by the state of ( PR ) . This identifiers is of the category "MEDICAID".
  • Identifier: 2530-2 . This is a "AMPR" identifier , issued by the state of ( PR ) . This identifiers is of the category "OTHER".
  • Identifier: 660433481 . This is a "MCS" identifier , issued by the state of ( PR ) . This identifiers is of the category "OTHER".
  • Identifier: 2660127 . This is a "HUMANA" identifier , issued by the state of ( PR ) . This identifiers is of the category "OTHER".
  • Identifier: 660433481-05 . This is a "GOLDEN CROSS" identifier , issued by the state of ( PR ) . This identifiers is of the category "OTHER".
  • Identifier: 30260 . This is a "CRUZ AZUL" identifier , issued by the state of ( PR ) . This identifiers is of the category "OTHER".




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