Provider Demographics
NPI:1437433927
Name:ASSMCA
Entity Type:Organization
Organization Name:ASSMCA
Other - Org Name:PROGRAMA DE VUELTA A LA VIDA
Other - Org Type:Other Name
Authorized Official - Title/Position:NURSE
Authorized Official - Prefix:MR
Authorized Official - First Name:JOSE
Authorized Official - Middle Name:A
Authorized Official - Last Name:CHEVERE
Authorized Official - Suffix:
Authorized Official - Credentials:LPN
Authorized Official - Phone:787-463-9094
Mailing Address - Street 1:H20 CALLE A
Mailing Address - Street 2:
Mailing Address - City:CAROLINA
Mailing Address - State:PR
Mailing Address - Zip Code:00985-5565
Mailing Address - Country:US
Mailing Address - Phone:787-463-9094
Mailing Address - Fax:
Practice Address - Street 1:H20 CALLE A
Practice Address - Street 2:
Practice Address - City:CAROLINA
Practice Address - State:PR
Practice Address - Zip Code:00985-5565
Practice Address - Country:US
Practice Address - Phone:787-463-9094
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-10-04
Last Update Date:2011-10-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR34657261QM0850X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0850XAmbulatory Health Care FacilitiesClinic/CenterAdult Mental Health