1841679834 NPI number — JIREH D&M INC

Table of content: (NPI 1841679834)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1841679834 NPI number — JIREH D&M INC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
JIREH D&M 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:
1841679834
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
07/27/2016
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 3155
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:
00613-3155
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
787-680-7778
Provider Business Mailing Address Fax Number:
787-680-7710

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
BO. HATO ABAJO URB. SAN RAFAEL CARR 492 KM 5.7
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
ARECIBO
Provider Business Practice Location Address State Name:
PR
Provider Business Practice Location Address Postal Code:
00612
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
787-680-7778
Provider Business Practice Location Address Fax Number:
787-680-7710
Provider Enumeration Date:
05/22/2015

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
GONZALEZ
Authorized Official First Name:
KAREN
Authorized Official Middle Name:
Authorized Official Title or Position:
PIC/DIRECTOR
Authorized Official Telephone Number:
787-431-1285

Provider Taxonomy Codes

  • Taxonomy code: 332B00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 332BN1400X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 333600000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 3336C0004X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 3336C0003X , with the licence number: 18-F-3379 , 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: 2152194 . This is a "PK" identifier . This identifiers is of the category "OTHER".