Healthcare Provider Details

I. General information

NPI: 1194852830
Provider Name (Legal Business Name): ADMINISTRACION DE SERVICES DE SALUD MENTAL CONTRA LA ADDICION
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/28/2007
Last Update Date: 09/09/2021
Certification Date: 09/09/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

CALLE MAGA FINAL PABELLON G, TERRENOS HOSP PSIQUIATRICO
SAN JUAN PR
00936
US

IV. Provider business mailing address

PO BOX 607087
BAYAMON PR
00960-7087
US

V. Phone/Fax

Practice location:
  • Phone: 787-763-7575
  • Fax:
Mailing address:
  • Phone: 787-763-7575
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM2800X
TaxonomyMethadone Clinic
License Number
License Number State

VIII. Authorized Official

Name: JIMMY BAEZ SALGADO
Title or Position: DIRECTOR DE FACTUACION
Credential: SR.
Phone: 787-763-7575