Provider Demographics
NPI:1891401832
Name:MINISTERIO RENOVAOS
Entity Type:Organization
Organization Name:MINISTERIO RENOVAOS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:CARLOS
Authorized Official - Middle Name:
Authorized Official - Last Name:RIVERA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:787-790-6867
Mailing Address - Street 1:BO. HATO NUEVO SECTOR LA PAJILLA
Mailing Address - Street 2:CARR. 173 KM 6.2
Mailing Address - City:GUAYNABO
Mailing Address - State:PR
Mailing Address - Zip Code:00970
Mailing Address - Country:US
Mailing Address - Phone:787-790-6867
Mailing Address - Fax:
Practice Address - Street 1:BO. HATO NUEVO SECTOR LA PAJILLA
Practice Address - Street 2:CARR. 173 KM 6.2
Practice Address - City:GUAYNABO
Practice Address - State:PR
Practice Address - Zip Code:00970
Practice Address - Country:US
Practice Address - Phone:787-790-6867
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-01-24
Last Update Date:2023-01-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR0405XAmbulatory Health Care FacilitiesClinic/CenterRehabilitation, Substance Use Disorder