Provider Demographics
NPI:1417330317
Name:EIGHTY TWO HEALTH CARE INC.
Entity Type:Organization
Organization Name:EIGHTY TWO HEALTH CARE INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:ARCILIO
Authorized Official - Middle Name:
Authorized Official - Last Name:ALVARADO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:787-306-8356
Mailing Address - Street 1:PO BOX 16327
Mailing Address - Street 2:
Mailing Address - City:SAN JUAN
Mailing Address - State:PR
Mailing Address - Zip Code:00908-6327
Mailing Address - Country:US
Mailing Address - Phone:787-279-7512
Mailing Address - Fax:
Practice Address - Street 1:530 AVE DE LA CONSTITUCION
Practice Address - Street 2:ATRIUM OFFICE CENTER SUITE 350
Practice Address - City:SAN JUAN
Practice Address - State:PR
Practice Address - Zip Code:00901-2304
Practice Address - Country:US
Practice Address - Phone:787-279-7512
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-07-09
Last Update Date:2015-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QH0100XAmbulatory Health Care FacilitiesClinic/CenterHealth Service
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR=========Medicaid