Provider Demographics
NPI:1497050538
Name:HOSPITAL SIQUIATRIA FORENSE
Entity Type:Organization
Organization Name:HOSPITAL SIQUIATRIA FORENSE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:REGISTERED NURSE
Authorized Official - Prefix:MR
Authorized Official - First Name:JOSE
Authorized Official - Middle Name:ANGEL
Authorized Official - Last Name:MATOS SANCHEZ
Authorized Official - Suffix:SR
Authorized Official - Credentials:RN
Authorized Official - Phone:787-844-0101
Mailing Address - Street 1:CONDOMINIO LOS FLAMBOYANES EDIFICIO 1 APARTAMENTO 410
Mailing Address - Street 2:
Mailing Address - City:PONCE
Mailing Address - State:PR
Mailing Address - Zip Code:00716-0000
Mailing Address - Country:US
Mailing Address - Phone:787-319-2622
Mailing Address - Fax:
Practice Address - Street 1:CONDOMINIO LOS FLAMBOYANES EDIFICIO 1 APARTAMENTO 410
Practice Address - Street 2:
Practice Address - City:PONCE
Practice Address - State:PR
Practice Address - Zip Code:00716-0000
Practice Address - Country:US
Practice Address - Phone:787-319-2622
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-01-21
Last Update Date:2011-01-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR16827282N00000X, 283Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes283Q00000XHospitalsPsychiatric Hospital
No282N00000XHospitalsGeneral Acute Care Hospital