Healthcare Provider Details

I. General information

NPI: 1568649200
Provider Name (Legal Business Name): ASOCIACION DE PUERTORRIQUENOS EN MARCHA, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/24/2008
Last Update Date: 01/22/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3263-65 N. FRONT STREET
PHILADELPHIA PA
19140
US

IV. Provider business mailing address

4301 RISING SUN AVE
PHILADELPHIA PA
19140-2719
US

V. Phone/Fax

Practice location:
  • Phone: 215-426-1077
  • Fax:
Mailing address:
  • Phone: 267-296-7200
  • Fax: 215-455-6501

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM0801X
TaxonomyMental Health Clinic/Center (Including Community Mental Health Center)
License Number134920
License Number StatePA

VIII. Authorized Official

Name: MS. NILDA RUIZ
Title or Position: EXECUTIVE DIRECTOR
Credential:
Phone: 267-296-7200