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General NPI Number Information
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NPI Number | 1417176603
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Entity Type | Organization
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Legal Business Name | CENTRO RESIDENCIAL VARONES PONCE
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Dates
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Enumeration Date | 04/25/2007
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Last Update Date | 08/07/2008
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Provider Practice Location Address
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Address Line | HOSPITAL SAN LUCAS 2
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City | PONCE
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State | PR
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Zip | 00732
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Country | US
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Telephone | 787-840-6835
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 21414
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City | SAN JUAN
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State | PR
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Zip | 00928-1414
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Country | US
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Telephone | 787-840-6835
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Fax |
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Authorized Official
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Title or Position | ADMINISTRATOR
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Name | MRS. ADA MATOS
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Credential |
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Telephone | 787-840-6835
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 324500000X
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Taxonomy Name | Substance Abuse Rehabilitation Facility
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License Number |
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License Number State | PR
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