Provider Demographics
NPI:1891035929
Name:TRANSFORMADOS HEALTH DETOX PSC
Entity Type:Organization
Organization Name:TRANSFORMADOS HEALTH DETOX PSC
Other - Org Name:TRANSFORMADOS HEALTH DETOX PSC
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:JUAN
Authorized Official - Middle Name:M
Authorized Official - Last Name:RIVERA
Authorized Official - Suffix:
Authorized Official - Credentials:SR
Authorized Official - Phone:787-859-2991
Mailing Address - Street 1:H28 CALLE 5
Mailing Address - Street 2:
Mailing Address - City:COROZAL
Mailing Address - State:PR
Mailing Address - Zip Code:00783-2304
Mailing Address - Country:US
Mailing Address - Phone:787-859-2991
Mailing Address - Fax:
Practice Address - Street 1:CARRT 821 KM 2.1 SECTOR EL CHAROL
Practice Address - Street 2:BO ABRAS
Practice Address - City:COROZAL
Practice Address - State:PR
Practice Address - Zip Code:00783
Practice Address - Country:US
Practice Address - Phone:787-859-2991
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-02-27
Last Update Date:2013-02-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes324500000XResidential Treatment FacilitiesSubstance Abuse Rehabilitation Facility