Healthcare Provider Details

I. General information

NPI: 1790588804
Provider Name (Legal Business Name): MIND IN MOTION
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/01/2025
Last Update Date: 04/01/2025
Certification Date: 04/01/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

#158 CALLE DR. SALAS
ARECIBO PR
00612
US

IV. Provider business mailing address

252 NORTHCOAST VLG
VEGA ALTA PR
00692-8714
US

V. Phone/Fax

Practice location:
  • Phone: 939-585-6295
  • Fax: 939-585-6295
Mailing address:
  • Phone: 939-585-6295
  • Fax: 939-585-6295

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code323P00000X
TaxonomyPsychiatric Residential Treatment Facility
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code261QH0100X
TaxonomyHealth Service Clinic/Center
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code261QM0850X
TaxonomyAdult Mental Health Clinic/Center
License Number
License Number State
# 5
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State

VIII. Authorized Official

Name: MR. XAVIER ELIAS JIMENEZ HERNANDEZ
Title or Position: OWNER
Credential: MD,PA
Phone: 939-585-6295