Healthcare Provider Details

I. General information

NPI: 1285716126
Provider Name (Legal Business Name): ARNG
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/19/2006
Last Update Date: 08/06/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

CALLE #4 D39 CUIDAD INTER BOX595
BAYAMON PR
00956
US

IV. Provider business mailing address

CALLE #4 D39 CUIDAD INTER BUZON595
BAYAMON PR
00956
US

V. Phone/Fax

Practice location:
  • Phone: 787-797-0385
  • Fax:
Mailing address:
  • Phone: 787-797-0385
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code313M00000X
TaxonomyNursing Facility/Intermediate Care Facility
License Number18567
License Number StatePR

VIII. Authorized Official

Name: MRS. AIDA TORRES
Title or Position: MAILMAN
Credential:
Phone: 787-221-2788