1811338312 NPI number — BORINQUEN HEALTH CARE CENTER, INC.

Table of content: (NPI 1811338312)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1811338312 NPI number — BORINQUEN HEALTH CARE CENTER, INC.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
BORINQUEN HEALTH CARE CENTER, 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:
6
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:
1811338312
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
09/09/2022
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
3601 FEDERAL HWY
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
MIAMI
Provider Business Mailing Address State Name:
FL
Provider Business Mailing Address Postal Code:
33137-3795
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
305-576-6611
Provider Business Mailing Address Fax Number:
305-576-0008

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
7540 E TREASURE DR
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
NORTH BAY VILLAGE
Provider Business Practice Location Address State Name:
FL
Provider Business Practice Location Address Postal Code:
33141-4324
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
305-865-3141
Provider Business Practice Location Address Fax Number:
305-864-1729
Provider Enumeration Date:
07/12/2013

Additional Information

Authorized Official

Authorized Official Last Name:
VELEZ
Authorized Official First Name:
PAUL
Authorized Official Middle Name:
C.
Authorized Official Title or Position:
CEO / PRESIDENT
Authorized Official Telephone Number:
305-576-6611

Provider Taxonomy Codes

  • Taxonomy code: 261QF0400X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 029554036 . This is a "Florida Medicaid Provider ID" identifier , issued by the state of ( FL ) . This identifiers is of the category "MEDICAID".




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