Healthcare Provider Details

I. General information

NPI: 1891035929
Provider Name (Legal Business Name): TRANSFORMADOS HEALTH DETOX PSC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/27/2013
Last Update Date: 02/27/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

CARRT 821 KM 2.1 SECTOR EL CHAROL BO ABRAS
COROZAL PR
00783
US

IV. Provider business mailing address

H28 CALLE 5
COROZAL PR
00783-2304
US

V. Phone/Fax

Practice location:
  • Phone: 787-859-2991
  • Fax:
Mailing address:
  • Phone: 787-859-2991
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code324500000X
TaxonomySubstance Abuse Rehabilitation Facility
License Number
License Number State

VIII. Authorized Official

Name: MR. JUAN M RIVERA
Title or Position: DIRECTOR
Credential: SR
Phone: 787-859-2991