1467942813 NPI number — MIGRANT HEALTH CENTER WESTERN REGION, INC.

Table of content: (NPI 1467942813)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1467942813 NPI number — MIGRANT HEALTH CENTER WESTERN REGION, INC.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
MIGRANT HEALTH CENTER WESTERN REGION, 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:
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:
1467942813
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
03/08/2021
NPI Deactivation Reason Code:
NPI Deactivation Date:
02/25/2020
NPI Reactivation Date:
03/08/2021

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 190
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
MAYAGUEZ
Provider Business Mailing Address State Name:
PR
Provider Business Mailing Address Postal Code:
00681-0190
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
BO. PLANAS CARR. #457 KM 2.2 BO. PLANAS
Provider Second Line Business Practice Location Address:
MIGRANT HEALTH CENTER WESTERN REGION, INC FQHC
Provider Business Practice Location Address City Name:
ISABELA
Provider Business Practice Location Address State Name:
PR
Provider Business Practice Location Address Postal Code:
00662
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
787-830-0243
Provider Business Practice Location Address Fax Number:
787-830-1240
Provider Enumeration Date:
05/11/2018

Additional Information

Authorized Official

Authorized Official Last Name:
TORRES
Authorized Official First Name:
DOLORES
Authorized Official Middle Name:
MORALES
Authorized Official Title or Position:
CEO
Authorized Official Telephone Number:
787-613-6918

Provider Taxonomy Codes

  • Taxonomy code: 261QM0801X , with the licence number:  294351 , 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)





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