Healthcare Provider Details

I. General information

NPI: 1649626383
Provider Name (Legal Business Name): ARCANGEL CORP
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/12/2016
Last Update Date: 05/12/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3 CALLE I BO. CAMPO ALEGRE
HATILLO PR
00659
US

IV. Provider business mailing address

HC 01 05 BOX 58600
HATILLO PR
00659
US

V. Phone/Fax

Practice location:
  • Phone: 787-501-1133
  • Fax:
Mailing address:
  • Phone: 787-501-1133
  • Fax: 787-680-7736

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code323P00000X
TaxonomyPsychiatric Residential Treatment Facility
License Number2095803
License Number StatePR

VIII. Authorized Official

Name: MR. ERICK LOPEZ
Title or Position: ENCARGADO
Credential:
Phone: 787-501-1133