Provider Demographics
NPI:1760846448
Name:FIRST HEALTH SYSTEM, INC.
Entity Type:Organization
Organization Name:FIRST HEALTH SYSTEM, INC.
Other - Org Name:FHS CIDRA
Other - Org Type:Other Name
Authorized Official - Title/Position:FHS GOVERNMENT HEALTH PLAN
Authorized Official - Prefix:MRS
Authorized Official - First Name:HUARALI
Authorized Official - Middle Name:
Authorized Official - Last Name:REYES AVILES
Authorized Official - Suffix:
Authorized Official - Credentials:LCDA
Authorized Official - Phone:787-622-9797
Mailing Address - Street 1:17 CALLE 2 STE 520
Mailing Address - Street 2:
Mailing Address - City:GUAYNABO
Mailing Address - State:PR
Mailing Address - Zip Code:00968-1750
Mailing Address - Country:US
Mailing Address - Phone:787-622-9797
Mailing Address - Fax:844-226-1440
Practice Address - Street 1:12 CALLE ROMAN BALDORIOTY DE CASTRO
Practice Address - Street 2:
Practice Address - City:CIDRA
Practice Address - State:PR
Practice Address - Zip Code:00739
Practice Address - Country:US
Practice Address - Phone:787-247-9542
Practice Address - Fax:787-434-0317
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-04-08
Last Update Date:2016-04-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0850XAmbulatory Health Care FacilitiesClinic/CenterAdult Mental Health
No261QM0855XAmbulatory Health Care FacilitiesClinic/CenterAdolescent and Children Mental Health