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General NPI Number Information
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NPI Number | 1598363954
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Entity Type | Organization
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Legal Business Name | TEEN CHALLENGE DE PUERTO RICO, INC.
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Dates
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Enumeration Date | 10/16/2020
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Last Update Date | 03/24/2025
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Provider Practice Location Address
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Address Line | CARRETERA #2 KM 7.7
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City | BAYAMON
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State | PR
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Zip | 00958-4273
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Country | US
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Telephone | 787-730-6908
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 4273
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City | BAYAMON
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State | PR
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Zip | 00958-1273
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Country | US
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Telephone | 787-730-6908
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Fax |
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Authorized Official
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Title or Position | BILLER
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Name | OLGA J GOMEZ RIVERA
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Credential | PMB
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Telephone | 787-632-2072
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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 |
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