Healthcare Provider Details

I. General information

NPI: 1053600270
Provider Name (Legal Business Name): HOGAR LLEVANDO LUZ A LAS TINIEBLAS, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/29/2011
Last Update Date: 03/29/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

PR 782 KM.9 HM.7 BARRIO BAYAMONCITO SECTOR EL PUNTO
AGUAS BUENAS PR
00703
US

IV. Provider business mailing address

CALLE VIA PELICANO CK-9505 URB. CAMINO DEL MAR
TOA BAJA PR
00949-0000
US

V. Phone/Fax

Practice location:
  • Phone: 787-732-2323
  • Fax: 787-732-2525
Mailing address:
  • Phone: 787-732-2323
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QR0405X
TaxonomySubstance Use Disorder Rehabilitation Clinic/Center
License Number0589
License Number StatePR

VIII. Authorized Official

Name: MR. ARMANDO RIJOS
Title or Position: ADDICTION COUNSELOR
Credential: ADC
Phone: 787-378-4221