Healthcare Provider Details

I. General information

NPI: 1407830946
Provider Name (Legal Business Name): PUERTO RICAN ORGANIZATION TO MOTIVATE ENLIGHTEN AND SERVE ADDICTS INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/29/2005
Last Update Date: 07/15/2026
Certification Date: 07/15/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1776 CLAY AVE
BRONX NY
10457-7299
US

IV. Provider business mailing address

311 E 175TH ST
BRONX NY
10457-5859
US

V. Phone/Fax

Practice location:
  • Phone: 718-299-1100
  • Fax: 718-716-7822
Mailing address:
  • Phone: 718-960-7522
  • Fax: 718-583-6439

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QR0405X
TaxonomySubstance Use Disorder Rehabilitation Clinic/Center
License Number7000226R
License Number StateNY

VIII. Authorized Official

Name: BRIGHT AKHERE
Title or Position: DIRECTOR OF REVENUE MANAGEMENT
Credential:
Phone: 718-960-7605