MEDICARE: ADMINISTRACION DE SERVICIOS DE SALUD MENTAL Y CONTRA LA ADICCION

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	283Q00000X	Psychiatric Hospital	9	PR

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
3	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
4	2530-2	OTHER	PR	AMPR
5	660433481	OTHER	PR	MCS
6	2660127	OTHER	PR	HUMANA
7	660433481-05	OTHER	PR	GOLDEN CROSS
8	30260	OTHER	PR	CRUZ AZUL

General Provider Information

NPI Number	:	1598750192
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ADMINISTRACION DE SERVICIOS DE SALUD MENTAL Y CONTRA LA ADICCION

Provider Business Mailing Address
First Line	:	PO BOX 2100
Second Line	:
City	:	SAN JUAN
State	:	PR
Zip	:	00922-2100
Country	:	US
Telephone Number	:	787-766-4646
Fax Number	:	787-763-2344

Provider Business Practice Location Address
First Line	:	COND MAGA
Second Line	:	BO MONACILLOS CENTRO MEDICO
City	:	SAN JUAN
State	:	PR
Zip	:	00907-1966
Country	:	US
Telephone Number	:	787-766-4646
Fax Number	:	787-763-2344

Authorized Official
Title or Position	:	MANAGER
Name	:	JIMMY BAEZ SALGADO
Credential	:
Telephone Number	:	787-763-7575

Provider Enumeration Date	:	09/20/2005
Last Update Date	:	12/05/2018

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