Provider Demographics
NPI:1104044932
Name:ADMINISTRACION DE SERVICIOS DE SALUD MENTAL Y CONTRA LA ADICCION
Entity Type:Organization
Organization Name:ADMINISTRACION DE SERVICIOS DE SALUD MENTAL Y CONTRA LA ADICCION
Other - Org Name:ADMINISTRACION DE SERVICIOS DE SALUD MENTAL Y CONTRA LA ADICCION
Other - Org Type:Other Name
Authorized Official - Title/Position:AGENCY ADMINISTRATOR
Authorized Official - Prefix:DR
Authorized Official - First Name:JOSE
Authorized Official - Middle Name:
Authorized Official - Last Name:GALARZA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:787-763-7575
Mailing Address - Street 1:45 CALLE VIRTUD
Mailing Address - Street 2:
Mailing Address - City:PONCE
Mailing Address - State:PR
Mailing Address - Zip Code:00730-3801
Mailing Address - Country:US
Mailing Address - Phone:787-844-8795
Mailing Address - Fax:
Practice Address - Street 1:CARRETERA 14 TERRENO HOSP SAN LUC 2
Practice Address - Street 2:
Practice Address - City:PONCE
Practice Address - State:PR
Practice Address - Zip Code:00732
Practice Address - Country:US
Practice Address - Phone:787-840-6935
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-24
Last Update Date:2008-06-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR365324500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes324500000XResidential Treatment FacilitiesSubstance Abuse Rehabilitation Facility