Healthcare Provider Details

I. General information

NPI: 1659874519
Provider Name (Legal Business Name): PUERTO RICAN ASSOCIATION FOR HUMAN DEVELOPMENT, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/16/2018
Last Update Date: 06/11/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

100 1ST ST
PERTH AMBOY NJ
08861-4645
US

IV. Provider business mailing address

100 1ST ST
PERTH AMBOY NJ
08861-4645
US

V. Phone/Fax

Practice location:
  • Phone: 732-638-2830
  • Fax: 732-826-3082
Mailing address:
  • Phone: 732-638-2830
  • Fax: 732-826-3082

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License NumberHP0177700
License Number StateNJ

VIII. Authorized Official

Name: MS. BLANCA GUERRERO
Title or Position: MANAGER
Credential:
Phone: 732-638-2830