Provider Demographics
NPI:1861008971
Name:REHACIENDO COMUNIDADES CON ESPERANZA, INC.
Entity Type:Organization
Organization Name:REHACIENDO COMUNIDADES CON ESPERANZA, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTE DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:GLORYMAR
Authorized Official - Middle Name:
Authorized Official - Last Name:RIVERA-BAEZ
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:787-220-4440
Mailing Address - Street 1:PO BOX 23339
Mailing Address - Street 2:
Mailing Address - City:SAN JUAN
Mailing Address - State:PR
Mailing Address - Zip Code:00931-3339
Mailing Address - Country:US
Mailing Address - Phone:787-220-4440
Mailing Address - Fax:
Practice Address - Street 1:8 CALLE MARIANA BRACETTI
Practice Address - Street 2:
Practice Address - City:SAN JUAN
Practice Address - State:PR
Practice Address - Zip Code:00925-2201
Practice Address - Country:US
Practice Address - Phone:787-765-3195
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-09-23
Last Update Date:2020-09-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologistGroup - Single Specialty