1457806895 NPI number — AMADA HEALTH CARE

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 1457806895 NPI number — AMADA HEALTH CARE

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
AMADA HEALTH CARE
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:
1457806895
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
01/17/2017
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
209 CIRCULO C
Provider Second Line Business Mailing Address:
BASE RAMEY
Provider Business Mailing Address City Name:
AGUADILLA
Provider Business Mailing Address State Name:
PR
Provider Business Mailing Address Postal Code:
00603-1246
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
787-868-0906
Provider Business Mailing Address Fax Number:
787-868-0906

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
CARR 2 KM 137.8
Provider Second Line Business Practice Location Address:
BARRIO CERRO GORDO
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:
787-868-0906
Provider Business Practice Location Address Fax Number:
787-868-0906
Provider Enumeration Date:
08/15/2016

Additional Information

Authorized Official

Authorized Official Last Name:
GOMEZ
Authorized Official First Name:
ROXANA
Authorized Official Middle Name:
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
787-923-1321

Provider Taxonomy Codes

  • Taxonomy code: 314000000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





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