1295000347 NPI number — SAN JUAN AGING CENTER

Table of content: (NPI 1295000347)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1295000347 NPI number — SAN JUAN AGING CENTER

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
SAN JUAN AGING CENTER
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:
1295000347
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
03/21/2012
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1187 CALLE 46 SE
Provider Second Line Business Mailing Address:
REPARTO METROPOLITANO
Provider Business Mailing Address City Name:
SAN JUAN
Provider Business Mailing Address State Name:
PR
Provider Business Mailing Address Postal Code:
00921-2625
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
787-480-5402
Provider Business Mailing Address Fax Number:
787-649-9904

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1187 CALLE 46 SE
Provider Second Line Business Practice Location Address:
URBANIZACION REPARTO METROPOLITANO
Provider Business Practice Location Address City Name:
SAN JUAN
Provider Business Practice Location Address State Name:
PR
Provider Business Practice Location Address Postal Code:
00921-2625
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
787-480-5402
Provider Business Practice Location Address Fax Number:
787-764-9904
Provider Enumeration Date:
03/21/2012

Additional Information

Authorized Official

Authorized Official Last Name:
COTTO
Authorized Official First Name:
JOSEFA
Authorized Official Middle Name:
Authorized Official Title or Position:
SUP. DEP DE FACTURACION
Authorized Official Telephone Number:
787-480-3876

Provider Taxonomy Codes

  • Taxonomy code: 311ZA0620X , with the licence number:  25487 , 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: 25487 . This is a "NURSE LICENSE" identifier , issued by the state of ( PR ) . This identifiers is of the category "OTHER".




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