Provider Demographics
NPI:1841416807
Name:CENTRO DE SERVICIOS DE APOYO E INTERVENCION TEMPRANA CRECIENDO JUNTOS
Entity Type:Organization
Organization Name:CENTRO DE SERVICIOS DE APOYO E INTERVENCION TEMPRANA CRECIENDO JUNTOS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:MISS
Authorized Official - First Name:ELIZABETH
Authorized Official - Middle Name:RIVERA
Authorized Official - Last Name:MENDEZ
Authorized Official - Suffix:
Authorized Official - Credentials:THL
Authorized Official - Phone:787-623-2869
Mailing Address - Street 1:PANAMA STREET # 3
Mailing Address - Street 2:74 URBANIZACION SANTA TERESA
Mailing Address - City:MANATI
Mailing Address - State:PR
Mailing Address - Zip Code:00674
Mailing Address - Country:US
Mailing Address - Phone:787-623-2869
Mailing Address - Fax:
Practice Address - Street 1:74 URBANIZACION SANTA TERESA
Practice Address - Street 2:
Practice Address - City:MANATI
Practice Address - State:PR
Practice Address - Zip Code:00674
Practice Address - Country:US
Practice Address - Phone:787-623-2869
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-18
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR569235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language PathologistGroup - Multi-Specialty