MEDICARE: ASOCIACION DE PUERTORRIQUENOS EN MARCHA, INC.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	261QM0801X	Mental Health Clinic/Center (Including Community Mental Health Center)	807241	PA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1497932479
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ASOCIACION DE PUERTORRIQUENOS EN MARCHA, INC.

Provider Business Mailing Address
First Line	:	1900 N 9TH ST
Second Line	:
City	:	PHILADELPHIA
State	:	PA
Zip	:	19122-2024
Country	:	US
Telephone Number	:	267-296-7200
Fax Number	:	215-687-8954

Provider Business Practice Location Address
First Line	:	4301 RISING SUN AVE
Second Line	:
City	:	PHILADELPHIA
State	:	PA
Zip	:	19140-2719
Country	:	US
Telephone Number	:	267-296-7220
Fax Number	:	215-324-1153

Authorized Official
Title or Position	:	EXECUTIVE DIRECTOR
Name	:	MS. NILDA RUIZ
Credential	:
Telephone Number	:	267-296-7200

Provider Enumeration Date	:	01/22/2008
Last Update Date	:	02/12/2016

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