1316262397 NPI number — JALOU INC

Table of content: (NPI 1316262397)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1316262397 NPI number — JALOU INC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
JALOU INC
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:
THE VISUAL CORNER
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:
1316262397
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
05/25/2011
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
AVE.PONCE DE LEON 735, STE 25
Provider Second Line Business Mailing Address:
TORRE MEDICA AUXILIO MUTUO
Provider Business Mailing Address City Name:
SAN JUAN
Provider Business Mailing Address State Name:
PR
Provider Business Mailing Address Postal Code:
00917
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
787-767-4200
Provider Business Mailing Address Fax Number:
787-767-4200

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
AVE.PONCE DE LEON 735, SUITE 25
Provider Second Line Business Practice Location Address:
TORRE MEDICA AUXILIO MUTUO
Provider Business Practice Location Address City Name:
SAN JUAN
Provider Business Practice Location Address State Name:
PR
Provider Business Practice Location Address Postal Code:
00917
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
787-767-4200
Provider Business Practice Location Address Fax Number:
787-767-4200
Provider Enumeration Date:
04/01/2010

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
GONZALEZ
Authorized Official First Name:
MARIA
Authorized Official Middle Name:
L
Authorized Official Title or Position:
VICE-PRESIDENT
Authorized Official Telephone Number:
787-767-4200

Provider Taxonomy Codes

  • Taxonomy code: 152W00000X , 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)