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General NPI Number Information
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NPI Number | 1790588804
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Entity Type | Organization
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Legal Business Name | MIND IN MOTION
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Dates
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Enumeration Date | 04/01/2025
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Last Update Date | 04/01/2025
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Provider Practice Location Address
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Address Line | #158 CALLE DR. SALAS
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City | ARECIBO
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State | PR
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Zip | 00612
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Country | US
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Telephone | 939-585-6295
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Fax | 939-585-6295
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Provider Business Mailing Address
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Address Line | 252 NORTHCOAST VLG
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City | VEGA ALTA
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State | PR
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Zip | 00692-8714
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Country | US
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Telephone | 939-585-6295
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Fax | 939-585-6295
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Authorized Official
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Title or Position | OWNER
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Name | MR. XAVIER ELIAS JIMENEZ HERNANDEZ
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Credential | MD,PA
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Telephone | 939-585-6295
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 323P00000X
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Taxonomy Name | Psychiatric Residential Treatment Facility
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 251S00000X
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Taxonomy Name | Community/Behavioral Health Agency
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 261QH0100X
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Taxonomy Name | Health Service Clinic/Center
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License Number |
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License Number State |
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Taxonomy #4
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Taxonomy Code | 261QM0850X
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Taxonomy Name | Adult Mental Health Clinic/Center
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License Number |
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License Number State |
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Taxonomy #5
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Taxonomy Code | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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License Number |
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License Number State |
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