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General NPI Number Information
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NPI Number | 1255749396
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Entity Type | Organization
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Legal Business Name | T&C MENTAL HEALTH HOME SERVICE, INC
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Dates
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Enumeration Date | 07/31/2014
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Last Update Date | 07/31/2014
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Provider Practice Location Address
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Address Line | SENDEROS DEL RIO 860 CARR.175 APT. 1406
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City | SAN JUAN
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State | PR
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Zip | 00926
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Country | US
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Telephone | 787-614-3006
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Fax | 787-545-2543
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Provider Business Mailing Address
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Address Line | SENDEROS DEL RIO 860 CARR.175 APT. 1406
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City | SAN JUAN
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State | PR
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Zip | 00926
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Country | US
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Telephone | 787-614-3006
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Fax | 787-545-2543
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Authorized Official
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Title or Position | CEO
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Name | DR. REGINO CRUZ
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Credential | M.D.
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Telephone | 787-614-3006
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 320800000X
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Taxonomy Name | Mental Illness Community Based Residential Treatment Facility
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License Number | 9855
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License Number State | PR
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