Provider Demographics
NPI:1619363397
Name:MENNONITE GENERAL HOSPITAL, INC
Entity Type:Organization
Organization Name:MENNONITE GENERAL HOSPITAL, INC
Other - Org Name:CENTRO DE SALUD CONDUCTUAL MENONITA CIMA AIBONITO
Other - Org Type:Doing Business As
Authorized Official - Title/Position:DIRECTORA FACTYRACION Y COBRO
Authorized Official - Prefix:
Authorized Official - First Name:LISSETTE
Authorized Official - Middle Name:
Authorized Official - Last Name:VASQUEZ RIVERA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:765-434-1700
Mailing Address - Street 1:PO BOX 871
Mailing Address - Street 2:
Mailing Address - City:AIBONITO
Mailing Address - State:PR
Mailing Address - Zip Code:00705-0871
Mailing Address - Country:US
Mailing Address - Phone:787-434-1700
Mailing Address - Fax:787-735-3749
Practice Address - Street 1:CALLE SARGENTO GERARDO SANTIAGO CARRETERA 14 INTERIOR
Practice Address - Street 2:
Practice Address - City:AIBONITO
Practice Address - State:PR
Practice Address - Zip Code:00705-1379
Practice Address - Country:US
Practice Address - Phone:787-535-1001
Practice Address - Fax:787-535-1114
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-04-09
Last Update Date:2020-06-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR6OtherLICENCIA SALUD