Provider Demographics
NPI: | 1487040267 |
---|---|
Name: | CDC GROUP SERVICES INC |
Entity Type: | Organization |
Organization Name: | CDC GROUP SERVICES INC |
Other - Org Name: | |
Other - Org Type: | |
Authorized Official - Title/Position: | ADMINISTRATOR |
Authorized Official - Prefix: | MRS |
Authorized Official - First Name: | DELGIA |
Authorized Official - Middle Name: | |
Authorized Official - Last Name: | CRUZ |
Authorized Official - Suffix: | |
Authorized Official - Credentials: | CPL |
Authorized Official - Phone: | 787-598-4528 |
Mailing Address - Street 1: | PO BOX 893 |
Mailing Address - Street 2: | |
Mailing Address - City: | JUANA DIAZ |
Mailing Address - State: | PR |
Mailing Address - Zip Code: | 00795-0893 |
Mailing Address - Country: | US |
Mailing Address - Phone: | 787-598-4528 |
Mailing Address - Fax: | 787-837-8668 |
Practice Address - Street 1: | 36 CALLE ESTRELLA |
Practice Address - Street 2: | |
Practice Address - City: | PONCE |
Practice Address - State: | PR |
Practice Address - Zip Code: | 00730-3832 |
Practice Address - Country: | US |
Practice Address - Phone: | 787-598-4528 |
Practice Address - Fax: | |
EIN: | <UNAVAIL> |
Is Organization Subpart?: | No |
Parent Organization LBN: | |
Parent Organization TIN: | |
Enumeration Date: | 2015-04-08 |
Last Update Date: | 2015-04-08 |
Deactivation Date: | |
Deactivation Code: | |
Reactivation Date: |
Provider Licenses
State | License ID | Taxonomies |
---|---|---|
PR | 4010 | 101YP2500X |
Provider Taxonomies
Primary? | Code | Type | Classification | Specialization | Group |
---|---|---|---|---|---|
Yes | 101YP2500X | Behavioral Health & Social Service Providers | Counselor | Professional | Group - Multi-Specialty |