1508542101 NPI number — PROCARE HEALTH CARE ALLIANCE

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1508542101 NPI number — PROCARE HEALTH CARE ALLIANCE

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
PROCARE HEALTH CARE ALLIANCE
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:
1508542101
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
06/27/2023
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
HC 3 BOX 39603
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
AGUADA
Provider Business Mailing Address State Name:
PR
Provider Business Mailing Address Postal Code:
00602-9794
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
787-868-0345
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
BARRIO ASOMANTE
Provider Second Line Business Practice Location Address:
CARR 115 KM 24.5
Provider Business Practice Location Address City Name:
AGUADA
Provider Business Practice Location Address State Name:
PR
Provider Business Practice Location Address Postal Code:
00602
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
787-868-0345
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
06/27/2023

Additional Information

Authorized Official

Authorized Official Last Name:
ORTEGA
Authorized Official First Name:
HIRAM
Authorized Official Middle Name:
Authorized Official Title or Position:
PRESENT
Authorized Official Telephone Number:
787-868-0345

Provider Taxonomy Codes

  • Taxonomy code: 171M00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





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