Provider Demographics
NPI:1154814408
Name:RC BEHAVIORAL WELNESS LLC
Entity Type:Organization
Organization Name:RC BEHAVIORAL WELNESS LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:JAN
Authorized Official - Middle Name:CARLOS
Authorized Official - Last Name:ROMAN ITHIER
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:787-396-2181
Mailing Address - Street 1:PO BOX 3633
Mailing Address - Street 2:
Mailing Address - City:MAYAGUEZ
Mailing Address - State:PR
Mailing Address - Zip Code:00681-3633
Mailing Address - Country:US
Mailing Address - Phone:787-396-2181
Mailing Address - Fax:
Practice Address - Street 1:740 AVE HOSTOS
Practice Address - Street 2:COND MEDICAL CENTER PLAZA, OFFICE 304
Practice Address - City:MAYAGUEZ
Practice Address - State:PR
Practice Address - Zip Code:00680
Practice Address - Country:US
Practice Address - Phone:787-396-2181
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-06-12
Last Update Date:2018-06-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR185022084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatryGroup - Single Specialty