Provider Demographics
NPI:1629047105
Name:ROVICO HEALTH CARE ADMINISTRATIVE AND CONSULTING SERVICES INC
Entity Type:Organization
Organization Name:ROVICO HEALTH CARE ADMINISTRATIVE AND CONSULTING SERVICES INC
Other - Org Name:CLINICA PARA EL CUIDADO Y TRATAMIENTO DE LA CONDUCTA
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MS
Authorized Official - First Name:RUTH
Authorized Official - Middle Name:M
Authorized Official - Last Name:ORTIZ
Authorized Official - Suffix:
Authorized Official - Credentials:MHSA,RHIA
Authorized Official - Phone:787-806-1835
Mailing Address - Street 1:PO BOX 880
Mailing Address - Street 2:
Mailing Address - City:MAYAGUEZ
Mailing Address - State:PR
Mailing Address - Zip Code:00681-0880
Mailing Address - Country:US
Mailing Address - Phone:787-806-1835
Mailing Address - Fax:787-986-1835
Practice Address - Street 1:237 AVE. FLAMBOYAN
Practice Address - Street 2:ROAD 116 KM.2
Practice Address - City:LAJAS
Practice Address - State:PR
Practice Address - Zip Code:00667-2509
Practice Address - Country:US
Practice Address - Phone:787-808-1835
Practice Address - Fax:787-899-1835
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-03-16
Last Update Date:2010-09-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PRCASM0232261QM0801X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR=========OtherCOSVI
PR404615Medicare ID - Type Unspecified