Healthcare Provider Details

I. General information

NPI: 1508849993
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: 11/21/2005
Last Update Date: 09/23/2022
Certification Date: 09/23/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1776 CLAY AVENUE
BRONX NY
10457
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: 718-960-7568
  • Fax: 718-716-7822

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code261QR0405X
TaxonomySubstance Use Disorder Rehabilitation Clinic/Center
License Number170912043
License Number StateNY
# 2
Primary TaxonomyY
Taxonomy Code261QM2800X
TaxonomyMethadone Clinic
License Number
License Number StateNY

VIII. Authorized Official

Name: VICKY GATELL
Title or Position: CHIEF FINANCIAL OFFICER
Credential:
Phone: 718-960-7568