Provider Demographics
NPI: | 1760623094 |
---|---|
Name: | INTEGRATE COMMUNITY HEALTH SYSTEM |
Entity Type: | Organization |
Organization Name: | INTEGRATE COMMUNITY HEALTH SYSTEM |
Other - Org Name: | METRO PAVIA CLINIC HUMACAO - DENTAL |
Other - Org Type: | Doing Business As |
Authorized Official - Title/Position: | PRESIDENT |
Authorized Official - Prefix: | |
Authorized Official - First Name: | VIVIAN |
Authorized Official - Middle Name: | |
Authorized Official - Last Name: | SOLIVAN |
Authorized Official - Suffix: | |
Authorized Official - Credentials: | |
Authorized Official - Phone: | 787-650-7294 |
Mailing Address - Street 1: | PO BOX 455 |
Mailing Address - Street 2: | 400 CALLE CALAF |
Mailing Address - City: | SAN JUAN |
Mailing Address - State: | PR |
Mailing Address - Zip Code: | 00918 |
Mailing Address - Country: | US |
Mailing Address - Phone: | 787-234-8865 |
Mailing Address - Fax: | 787-274-8895 |
Practice Address - Street 1: | CARR 924 PLAZA 2000 |
Practice Address - Street 2: | JARDINES DE HUMACAO |
Practice Address - City: | HUMACAO |
Practice Address - State: | PR |
Practice Address - Zip Code: | 00791 |
Practice Address - Country: | US |
Practice Address - Phone: | 787-234-8865 |
Practice Address - Fax: | 787-660-7256 |
EIN: | <UNAVAIL> |
Is Organization Subpart?: | No |
Parent Organization LBN: | |
Parent Organization TIN: | |
Enumeration Date: | 2009-03-17 |
Last Update Date: | 2016-05-26 |
Deactivation Date: | |
Deactivation Code: | |
Reactivation Date: |
Provider Taxonomies
Primary? | Code | Type | Classification | Specialization |
---|---|---|---|---|
Yes | 261QD0000X | Ambulatory Health Care Facilities | Clinic/Center | Dental |