Provider Demographics
NPI:1508109067
Name:MIR NURSING SERVICES
Entity Type:Organization
Organization Name:MIR NURSING SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MSN
Authorized Official - Prefix:MRS
Authorized Official - First Name:MARIA
Authorized Official - Middle Name:ISABEL
Authorized Official - Last Name:RIVERA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:787-605-1622
Mailing Address - Street 1:C ST-14 K-35
Mailing Address - Street 2:VILLAS DEL CAFETAL
Mailing Address - City:YAUCO
Mailing Address - State:PUERTO RICO
Mailing Address - Zip Code:00698
Mailing Address - Country:UM
Mailing Address - Phone:787-605-1622
Mailing Address - Fax:
Practice Address - Street 1:C ST-14 K-35
Practice Address - Street 2:VILLAS DEL CAFETAL
Practice Address - City:YAUCO
Practice Address - State:PUERTO RICO
Practice Address - Zip Code:00698
Practice Address - Country:UM
Practice Address - Phone:787-605-1622
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-04-03
Last Update Date:2013-04-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR986320900000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes320900000XResidential Treatment FacilitiesCommunity Based Residential Treatment Facility, Intellectual and/or Developmental Disabilities