Provider Demographics
NPI:1669838454
Name:ACCOUNTABLE CARE GROUP OF PUERTO RICO LLC
Entity Type:Organization
Organization Name:ACCOUNTABLE CARE GROUP OF PUERTO RICO LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:REP ADMINISTRATION
Authorized Official - Prefix:
Authorized Official - First Name:IRIS
Authorized Official - Middle Name:
Authorized Official - Last Name:CLEMENTE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:787-407-3411
Mailing Address - Street 1:PO BOX 8445
Mailing Address - Street 2:
Mailing Address - City:CAGUAS
Mailing Address - State:PR
Mailing Address - Zip Code:00726-8445
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:M11 CALLE 16
Practice Address - Street 2:CASTELLANA GARDENS
Practice Address - City:CAROLINA
Practice Address - State:PR
Practice Address - Zip Code:00983-1933
Practice Address - Country:US
Practice Address - Phone:787-407-3411
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-01-08
Last Update Date:2016-01-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes171M00000XOther Service ProvidersCase Manager/Care CoordinatorGroup - Multi-Specialty