Provider Demographics
NPI:1003299934
Name:PEDIATRIC MEDICAL HOME CENTER, INC
Entity Type:Organization
Organization Name:PEDIATRIC MEDICAL HOME CENTER, INC
Other - Org Name:PEDIATRIC MEDICAL HOME
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:IRVIN
Authorized Official - Middle Name:D
Authorized Official - Last Name:VALENTIN
Authorized Official - Suffix:
Authorized Official - Credentials:MBA
Authorized Official - Phone:787-242-8990
Mailing Address - Street 1:E1 CALLE GARFIELD
Mailing Address - Street 2:PARKVILLE SUR
Mailing Address - City:GUAYNABO
Mailing Address - State:PR
Mailing Address - Zip Code:00969-4415
Mailing Address - Country:US
Mailing Address - Phone:787-242-8990
Mailing Address - Fax:787-200-6712
Practice Address - Street 1:E1 CALLE GARFIELD
Practice Address - Street 2:PARKVILLE SUR
Practice Address - City:GUAYNABO
Practice Address - State:PR
Practice Address - Zip Code:00969-4415
Practice Address - Country:US
Practice Address - Phone:787-242-8990
Practice Address - Fax:787-200-6712
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-07-09
Last Update Date:2015-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR3140N1450X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3140N1450XNursing & Custodial Care FacilitiesSkilled Nursing FacilityNursing Care, Pediatric