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General NPI Number Information
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NPI Number | 1356746572
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Entity Type | Organization
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Legal Business Name | OPCION DE VIDA ' TU ALTERNATIVA' INC.
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Dates
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Enumeration Date | 10/30/2014
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Last Update Date | 10/30/2014
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Provider Practice Location Address
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Address Line | 437 CALLE FRATERNIDAD BARRIADA OBRERA
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City | FAJARDO
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State | PR
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Zip | 00738-4526
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Country | US
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Telephone | 787-364-1716
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Fax |
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Provider Business Mailing Address
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Address Line | 437 CALLE FRATERNIDAD BDA. OBRERA
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City | FAJARDO
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State | PR
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Zip | 00738-4526
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Country | US
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Telephone | 787-526-0680
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Fax |
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Authorized Official
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Title or Position | PRACTICE NURSE
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Name | MISS MARIA ALEJANDRA RIVERA RIOS
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Credential | LPN
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Telephone | 787-364-1716
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 311ZA0620X
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Taxonomy Name | Adult Care Home Facility
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License Number | 341545
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License Number State | PR
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