Provider Demographics
NPI:1114129889
Name:HOGAR DIVINO NINO JESUS
Entity Type:Organization
Organization Name:HOGAR DIVINO NINO JESUS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATIVE DIRECTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:CARLOS
Authorized Official - Middle Name:J
Authorized Official - Last Name:PACHECO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:787-794-0020
Mailing Address - Street 1:P O BOX 2464
Mailing Address - Street 2:
Mailing Address - City:TOA BAJA
Mailing Address - State:PR
Mailing Address - Zip Code:00951-2662
Mailing Address - Country:US
Mailing Address - Phone:787-794-0020
Mailing Address - Fax:787-794-3792
Practice Address - Street 1:CARRETERA 854 KM 3.5
Practice Address - Street 2:
Practice Address - City:TOA BAJA
Practice Address - State:PR
Practice Address - Zip Code:00951
Practice Address - Country:US
Practice Address - Phone:787-794-0020
Practice Address - Fax:787-794-3792
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-06-04
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PRCDTD0174323P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes323P00000XResidential Treatment FacilitiesPsychiatric Residential Treatment Facility