Provider Demographics
NPI:1003274853
Name:CENTRO TERAPEUTICO DEL NORESTE CORP
Entity Type:Organization
Organization Name:CENTRO TERAPEUTICO DEL NORESTE CORP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENTA
Authorized Official - Prefix:
Authorized Official - First Name:AIXNETTE
Authorized Official - Middle Name:
Authorized Official - Last Name:FIGUEROA AYALA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:787-368-4120
Mailing Address - Street 1:PO BOX 3507
Mailing Address - Street 2:
Mailing Address - City:RIO GRANDE
Mailing Address - State:PUERTO RICO
Mailing Address - Zip Code:00745
Mailing Address - Country:UM
Mailing Address - Phone:787-368-4120
Mailing Address - Fax:
Practice Address - Street 1:AVE JESUS T PINERO URB HYDE PARK 2DO NIVEL
Practice Address - Street 2:
Practice Address - City:SAN JUAN
Practice Address - State:PUERTO RICO
Practice Address - Zip Code:00927
Practice Address - Country:UM
Practice Address - Phone:787-368-4120
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:AIXNETTE FIGUEROA AYALA
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2016-02-08
Last Update Date:2016-02-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR111571041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Multi-Specialty