Provider Demographics
NPI:1528029238
Name:CENTRO DE SERVICIOS INTEGRADOS DE REHABILITACION
Entity Type:Organization
Organization Name:CENTRO DE SERVICIOS INTEGRADOS DE REHABILITACION
Other - Org Name:ASSMCA
Other - Org Type:Other Name
Authorized Official - Title/Position:MEDICAL DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:CARLOS
Authorized Official - Middle Name:J
Authorized Official - Last Name:NOGUERAS
Authorized Official - Suffix:I
Authorized Official - Credentials:MD
Authorized Official - Phone:787-738-2141
Mailing Address - Street 1:B-5 SAN MARTIN URB.
Mailing Address - Street 2:
Mailing Address - City:CAYEY
Mailing Address - State:PR
Mailing Address - Zip Code:00736
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:392 AVE JOSE DE DIEGO W
Practice Address - Street 2:
Practice Address - City:CAYEY
Practice Address - State:PR
Practice Address - Zip Code:00736-3747
Practice Address - Country:US
Practice Address - Phone:787-738-2141
Practice Address - Fax:787-263-4224
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-03-31
Last Update Date:2008-06-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR5110323P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes323P00000XResidential Treatment FacilitiesPsychiatric Residential Treatment Facility