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General NPI Number Information
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NPI Number | 1669838454
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Entity Type | Organization
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Legal Business Name | ACCOUNTABLE CARE GROUP OF PUERTO RICO LLC
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Dates
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Enumeration Date | 01/08/2016
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Last Update Date | 01/08/2016
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Provider Practice Location Address
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Address Line | M11 CALLE 16 CASTELLANA GARDENS
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City | CAROLINA
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State | PR
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Zip | 00983-1933
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Country | US
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Telephone | 787-407-3411
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 8445
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City | CAGUAS
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State | PR
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Zip | 00726-8445
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | REP ADMINISTRATION
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Name | IRIS CLEMENTE
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Credential |
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Telephone | 787-407-3411
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 171M00000X
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Taxonomy Name | Case Manager/Care Coordinator
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License Number |
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License Number State |
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