Provider Demographics
NPI:1598750192
Name:ADMINISTRACION DE SERVICIOS DE SALUD MENTAL Y CONTRA LA ADICCION
Entity Type:Organization
Organization Name:ADMINISTRACION DE SERVICIOS DE SALUD MENTAL Y CONTRA LA ADICCION
Other - Org Name:HOSPITAL PSIQUIATRICO DR. RAMON FERNANDEZ MARINA
Other - Org Type:Doing Business As
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:JIMMY
Authorized Official - Middle Name:
Authorized Official - Last Name:BAEZ SALGADO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:787-763-7575
Mailing Address - Street 1:PO BOX 2100
Mailing Address - Street 2:
Mailing Address - City:SAN JUAN
Mailing Address - State:PR
Mailing Address - Zip Code:00922-2100
Mailing Address - Country:US
Mailing Address - Phone:787-766-4646
Mailing Address - Fax:787-763-2344
Practice Address - Street 1:COND MAGA
Practice Address - Street 2:BO MONACILLOS CENTRO MEDICO
Practice Address - City:SAN JUAN
Practice Address - State:PR
Practice Address - Zip Code:00907-1966
Practice Address - Country:US
Practice Address - Phone:787-766-4646
Practice Address - Fax:787-763-2344
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-09-20
Last Update Date:2018-12-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR9283Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes283Q00000XHospitalsPsychiatric Hospital
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR45-9138Medicaid
PR482Medicaid
PRH-0260Medicaid
PR2530-2OtherAMPR
PR660433481OtherMCS
PR2660127OtherHUMANA
PR660433481-05OtherGOLDEN CROSS
PR30260OtherCRUZ AZUL
PR482Medicaid
PR660433481-05OtherGOLDEN CROSS
PR2530-2OtherAMPR