Provider Demographics
NPI:1639669096
Name:MIGRANT HEALTH CENTER WESTERN REGION, INC.
Entity Type:Organization
Organization Name:MIGRANT HEALTH CENTER WESTERN REGION, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTORA EJECUTIVA
Authorized Official - Prefix:MRS
Authorized Official - First Name:DOLORES
Authorized Official - Middle Name:MORALES
Authorized Official - Last Name:TORRES
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:787-613-6918
Mailing Address - Street 1:P O BOX 190
Mailing Address - Street 2:
Mailing Address - City:MAYAGUEZ
Mailing Address - State:PR
Mailing Address - Zip Code:00681
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:CARRETERA 101 KM 7.1
Practice Address - Street 2:BO PALMAREJO
Practice Address - City:LAJAS
Practice Address - State:PR
Practice Address - Zip Code:00667
Practice Address - Country:US
Practice Address - Phone:787-808-1420
Practice Address - Fax:787-834-1924
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-05-11
Last Update Date:2018-05-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR281232261QM0801X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)