Provider Demographics
NPI:1346641859
Name:INTEGRATED HEALTHCARE CENTER,INC
Entity Type:Organization
Organization Name:INTEGRATED HEALTHCARE CENTER,INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTORA CLINICA
Authorized Official - Prefix:MISS
Authorized Official - First Name:MARIA
Authorized Official - Middle Name:C
Authorized Official - Last Name:CRUZ
Authorized Official - Suffix:
Authorized Official - Credentials:PSYD
Authorized Official - Phone:787-722-9595
Mailing Address - Street 1:1551 CALLE VICTORIA
Mailing Address - Street 2:
Mailing Address - City:SANTURCE
Mailing Address - State:PR
Mailing Address - Zip Code:00912-3123
Mailing Address - Country:US
Mailing Address - Phone:787-722-9494
Mailing Address - Fax:
Practice Address - Street 1:1551 CALLE VICTORIA
Practice Address - Street 2:
Practice Address - City:SAN JUAN
Practice Address - State:PR
Practice Address - Zip Code:00912
Practice Address - Country:US
Practice Address - Phone:787-722-9494
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-09-16
Last Update Date:2014-09-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0855XAmbulatory Health Care FacilitiesClinic/CenterAdolescent and Children Mental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
PRHU355AMedicare UPIN