Healthcare Provider Details

I. General information

NPI: 1659580587
Provider Name (Legal Business Name): SAN JUAN CAPESTRANO HOSPITAL, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/21/2007
Last Update Date: 08/26/2023
Certification Date: 08/26/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

CARR 149 KM 7.5 BO ARRIBA SALIENTE
MANATI PR
00674
US

IV. Provider business mailing address

RR 2 BOX 11
SAN JUAN PR
00926-9767
US

V. Phone/Fax

Practice location:
  • Phone: 787-884-5700
  • Fax:
Mailing address:
  • Phone: 787-625-2900
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM0801X
TaxonomyMental Health Clinic/Center (Including Community Mental Health Center)
License Number55
License Number StatePR

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

# 1
Identifier10938
Identifier TypeOTHER
Identifier StatePR
Identifier IssuerSSS

VIII. Authorized Official

Name: BRIAN P. FARLEY
Title or Position: VICE PRESIDENT & SECRETARY
Credential:
Phone: 615-861-6000