Provider Demographics
NPI:1134102510
Name:MUNICIPALITY OF SAN JUAN PR
Entity Type:Organization
Organization Name:MUNICIPALITY OF SAN JUAN PR
Other - Org Name:SAN JUAN AGING CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:SUB-DIRECTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:GILBERTO
Authorized Official - Middle Name:
Authorized Official - Last Name:GONZALEZ
Authorized Official - Suffix:
Authorized Official - Credentials:LIC 1745
Authorized Official - Phone:787-480-3851
Mailing Address - Street 1:PO BOX 29395
Mailing Address - Street 2:
Mailing Address - City:SAN JUAN
Mailing Address - State:PR
Mailing Address - Zip Code:00929-0395
Mailing Address - Country:US
Mailing Address - Phone:787-764-9124
Mailing Address - Fax:787-764-9904
Practice Address - Street 1:AVE. 65TH INFANTERIA BO. SABANA LLANA
Practice Address - Street 2:
Practice Address - City:SAN JUAN
Practice Address - State:PR
Practice Address - Zip Code:00929
Practice Address - Country:US
Practice Address - Phone:787-764-9124
Practice Address - Fax:787-764-9904
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-11-21
Last Update Date:2013-05-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR2501325OtherACCA
PR4500121OtherACCA
PR9900144OtherACCA
PRP-113OtherFIRST MEDICAL
PR40081OtherPREFERRED MEDICARE CHOICE
PR820953OtherMMM
PR001365OtherAMERICAN HEALTH
PR6865041041OtherCRUZ AZUL
PR2501325OtherACCA
PR40081OtherPREFERRED MEDICARE CHOICE