1295177269 NPI number — EUREKA MENTAL HEALTH & WELLNES CENTER

Table of content: (NPI 1295177269)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1295177269 NPI number — EUREKA MENTAL HEALTH & WELLNES CENTER

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
EUREKA MENTAL HEALTH & WELLNES 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:
1295177269
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
07/19/2013
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 30500
Provider Second Line Business Mailing Address:
PMB 247
Provider Business Mailing Address City Name:
MANATI
Provider Business Mailing Address State Name:
PR
Provider Business Mailing Address Postal Code:
00674
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
787-427-4722
Provider Business Mailing Address Fax Number:
787-854-0650

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
PR-4494 KM 2.6
Provider Second Line Business Practice Location Address:
PLAZA CAMUY BUILDING
Provider Business Practice Location Address City Name:
CAMUY
Provider Business Practice Location Address State Name:
PR
Provider Business Practice Location Address Postal Code:
00627
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
787-427-4722
Provider Business Practice Location Address Fax Number:
787-854-0650
Provider Enumeration Date:
07/19/2013

Additional Information

Authorized Official

Authorized Official Last Name:
MEDINA
Authorized Official First Name:
SONIA
Authorized Official Middle Name:
MARIA
Authorized Official Title or Position:
DHIEF EXECUTIVE OFFICER
Authorized Official Telephone Number:
787-427-4722

Provider Taxonomy Codes

  • Taxonomy code: 261QM0850X , with the licence number:  005177 , registered in the state of PR ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 261QM0855X , with the licence number: 005177 , registered in the state of PR ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

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





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