Healthcare Provider Details

I. General information

NPI: 1023145471
Provider Name (Legal Business Name): CENTRO RESIDENCIAL DE VARONES DE SAN JUAN
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/27/2007
Last Update Date: 08/07/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

CALLE MAGA PABELLON B BO MONACILLOS
SAN JUAN PR
00926
US

IV. Provider business mailing address

PO BOX 21414
SAN JUAN PR
00928-1414
US

V. Phone/Fax

Practice location:
  • Phone: 787-274-1633
  • Fax:
Mailing address:
  • Phone: 787-274-1633
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: MRS. AIDA CRUZ
Title or Position: DIRECTOR
Credential:
Phone: 787-274-1633