1699384719 NPI number — CENTRO DE INTERVENCION Y BIENESTAR EMOCIONAL LPLLC

Table of content: (NPI 1699384719)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1699384719 NPI number — CENTRO DE INTERVENCION Y BIENESTAR EMOCIONAL LPLLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
CENTRO DE INTERVENCION Y BIENESTAR EMOCIONAL LPLLC
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:
CENTRO DE INTERVENCION Y BIENESTAR EMOCIONAL LPLLC
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:
1699384719
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
01/08/2022
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PMB 158 PO BOX 144100
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
ARECIBO
Provider Business Mailing Address State Name:
PR
Provider Business Mailing Address Postal Code:
00614-4100
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
939-334-4517
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
10 AVE ESTEVES
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
UTUADO
Provider Business Practice Location Address State Name:
PR
Provider Business Practice Location Address Postal Code:
00641-3025
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
939-334-4517
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
07/24/2020

Additional Information

Authorized Official

Authorized Official Last Name:
FELICIANO RIVERA
Authorized Official First Name:
YAIRALYS
Authorized Official Middle Name:
Authorized Official Title or Position:
PRESIDENTA
Authorized Official Telephone Number:
939-454-5572

Provider Taxonomy Codes

  • Taxonomy code: 251C00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 251E00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 251G00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 261Q00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 261QA0600X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 261QC1500X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 261QF0050X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 261QH0700X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 261QM0801X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 261QM0850X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 261QM0855X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 261QM1300X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 261QP2000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 261QR0400X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 261QX0100X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

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

  • Identifier: 039136000 , issued by the state of ( PR ) . This identifiers is of the category "MEDICAID".




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