1669635397 NPI number — NORTHEAST CORP

Table of content: (NPI 1669635397)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1669635397 NPI number — NORTHEAST CORP

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
NORTHEAST 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:
1669635397
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/26/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
AVE 1 URB SANTA RITA
Provider Second Line Business Mailing Address:
OFFICE 304
Provider Business Mailing Address City Name:
VEGA ALTA
Provider Business Mailing Address State Name:
PR
Provider Business Mailing Address Postal Code:
00692-0000
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
787-270-1345
Provider Business Mailing Address Fax Number:
787-270-1350

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
AVE 1 SANTA RITA
Provider Second Line Business Practice Location Address:
SUITE 304
Provider Business Practice Location Address City Name:
VEGA ALTA
Provider Business Practice Location Address State Name:
PR
Provider Business Practice Location Address Postal Code:
00692-0000
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
787-270-1345
Provider Business Practice Location Address Fax Number:
787-270-1350
Provider Enumeration Date:
07/02/2008

Additional Information

Authorized Official

Authorized Official Last Name:
SERRANO
Authorized Official First Name:
JOSE
Authorized Official Middle Name:
Authorized Official Title or Position:
ADMINISTRATOR
Authorized Official Telephone Number:
787-594-6383

Provider Taxonomy Codes

  • Taxonomy code: 261QA1903X , with the licence number:  31 , 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)

  • Identifier: 31 . This is a "HEALTH LICENCE" identifier , issued by the state of ( PR ) . This identifiers is of the category "OTHER".




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