Provider Demographics
NPI:1225694037
Name:MENNONITE GENERAL HOSPITAL INC
Entity Type:Organization
Organization Name:MENNONITE GENERAL HOSPITAL INC
Other - Org Name:CENTRO DE SALUD CONDUCTUAL CIMA PARCIAL CAGUAS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:DIRECTOR BILLING AND COLLECTOR
Authorized Official - Prefix:
Authorized Official - First Name:LISSETTE
Authorized Official - Middle Name:
Authorized Official - Last Name:VASQUEZ RIVERA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:787-714-2462
Mailing Address - Street 1:URB BONNEVILLE HEIGHTS
Mailing Address - Street 2:F35 CALLE 2 BO PUEBLO
Mailing Address - City:CAGUAS
Mailing Address - State:PR
Mailing Address - Zip Code:00725
Mailing Address - Country:US
Mailing Address - Phone:787-434-1700
Mailing Address - Fax:787-434-1715
Practice Address - Street 1:AVENIDA JOSE GAUTIER BENITEZ, NUMERO 230 BO. PUEBLO
Practice Address - Street 2:
Practice Address - City:CAGUAS
Practice Address - State:PR
Practice Address - Zip Code:00725-5546
Practice Address - Country:US
Practice Address - Phone:787-296-9776
Practice Address - Fax:787-735-3749
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-05-16
Last Update Date:2023-09-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR6OtherLICENCIA OPERACIONAL DEL DEPARTAMENTO DE SALUD