Provider Demographics
NPI:1447613609
Name:FIRST HEALTH SYSTEM, INC.
Entity Type:Organization
Organization Name:FIRST HEALTH SYSTEM, INC.
Other - Org Name:FHS HUMACAO
Other - Org Type:Other Name
Authorized Official - Title/Position:FHC GOVERNMENT HEALTH PLAN DIRECTOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:HUARALI
Authorized Official - Middle Name:
Authorized Official - Last Name:REYES AVILES
Authorized Official - Suffix:
Authorized Official - Credentials:LCDA
Authorized Official - Phone:787-622-9797
Mailing Address - Street 1:17 CALLE SUITE 520
Mailing Address - Street 2:
Mailing Address - City:GAUYNABO
Mailing Address - State:PR
Mailing Address - Zip Code:00968-1750
Mailing Address - Country:US
Mailing Address - Phone:787-622-9797
Mailing Address - Fax:844-226-1440
Practice Address - Street 1:CENTRO COMERCIAL HUMACAO
Practice Address - Street 2:EDIF 10A LOCAL 3 Y 4
Practice Address - City:HUMACAO
Practice Address - State:PR
Practice Address - Zip Code:00792
Practice Address - Country:US
Practice Address - Phone:787-248-1302
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:FHCHS OF PUERTO RICO INC.
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2016-04-04
Last Update Date:2016-04-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0850XAmbulatory Health Care FacilitiesClinic/CenterAdult Mental Health
No261QM0855XAmbulatory Health Care FacilitiesClinic/CenterAdolescent and Children Mental Health