1598561474 NPI number — PARADISE RIVER CORP

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 1598561474 NPI number — PARADISE RIVER CORP

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
PARADISE RIVER CORP
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:
1598561474
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
02/21/2025
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 733
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
ARROYO
Provider Business Mailing Address State Name:
PR
Provider Business Mailing Address Postal Code:
00714-0733
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
787-839-5775
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
BO. YAUREL SECTOR PALMAREJO
Provider Second Line Business Practice Location Address:
CARR 753 RR 7754 KM 0.7
Provider Business Practice Location Address City Name:
ARROYO
Provider Business Practice Location Address State Name:
PR
Provider Business Practice Location Address Postal Code:
00714
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
878-395-7757
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
02/21/2025

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
SANABRIA DE JESUS
Authorized Official First Name:
LUIS
Authorized Official Middle Name:
M
Authorized Official Title or Position:
ADMINISTRADOR
Authorized Official Telephone Number:
787-557-1097

Provider Taxonomy Codes

  • Taxonomy code: 311ZA0620X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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