Healthcare Provider Details

I. General information

NPI: 1942486717
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: 01/11/2008
Last Update Date: 12/18/2019
Certification Date: 12/18/2019
Deactivation Date:
Reactivation Date:

III. Provider practice location address

254 VIRGINIA ST
BUFFALO NY
14201
US

IV. Provider business mailing address

1776 CLAY AVE
BRONX NY
10457-7239
US

V. Phone/Fax

Practice location:
  • Phone: 716-768-4040
  • Fax:
Mailing address:
  • Phone: 718-299-1100
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QR0405X
TaxonomySubstance Use Disorder Rehabilitation Clinic/Center
License Number180711848
License Number StateNY

VIII. Authorized Official

Name: LYMARIS ALBORS
Title or Position: COO AND EVP
Credential:
Phone: 347-649-3295