Provider Demographics
NPI:1669635397
Name:NORTHEAST CORP
Entity Type:Organization
Organization Name:NORTHEAST CORP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:JOSE
Authorized Official - Middle Name:
Authorized Official - Last Name:SERRANO
Authorized Official - Suffix:
Authorized Official - Credentials:LIC
Authorized Official - Phone:787-594-6383
Mailing Address - Street 1:AVE 1 URB SANTA RITA
Mailing Address - Street 2:OFFICE 304
Mailing Address - City:VEGA ALTA
Mailing Address - State:PR
Mailing Address - Zip Code:00692-0000
Mailing Address - Country:US
Mailing Address - Phone:787-270-1345
Mailing Address - Fax:787-270-1350
Practice Address - Street 1:AVE 1 SANTA RITA
Practice Address - Street 2:SUITE 304
Practice Address - City:VEGA ALTA
Practice Address - State:PR
Practice Address - Zip Code:00692-0000
Practice Address - Country:US
Practice Address - Phone:787-270-1345
Practice Address - Fax:787-270-1350
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-07-02
Last Update Date:2008-08-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR31261QA1903X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA1903XAmbulatory Health Care FacilitiesClinic/CenterAmbulatory Surgical
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR31OtherHEALTH LICENCE