Provider Demographics
NPI:1578006300
Name:PUERTO RICAN FAMILY INSTITUTE, INC
Entity Type:Organization
Organization Name:PUERTO RICAN FAMILY INSTITUTE, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:IRAN
Authorized Official - Middle Name:
Authorized Official - Last Name:RODRIGUEZ
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:212-924-6320
Mailing Address - Street 1:145 W 15TH ST
Mailing Address - Street 2:2ND FLOOR
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10011-6701
Mailing Address - Country:US
Mailing Address - Phone:212-924-6320
Mailing Address - Fax:
Practice Address - Street 1:145 W 15TH ST
Practice Address - Street 2:2ND FLOOR
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10011-6701
Practice Address - Country:US
Practice Address - Phone:212-924-6320
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-11-28
Last Update Date:2016-11-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY6758110A251S00000X
NY6758101A251S00000X
NY6758102A251S00000X
NY06482440315P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health
No315P00000XNursing & Custodial Care FacilitiesIntermediate Care Facility, Intellectual Disabilities
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02999411Medicaid
NY00244880Medicaid
NY02999379Medicaid
NY02999420Medicaid
NY001113304Medicaid
NY00357126Medicaid
NY00357135Medicaid
NY01424217Medicaid