Provider Demographics
NPI:1255749396
Name:T&C MENTAL HEALTH HOME SERVICE, INC
Entity type:Organization
Organization Name:T&C MENTAL HEALTH HOME SERVICE, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:DR
Authorized Official - First Name:REGINO
Authorized Official - Middle Name:
Authorized Official - Last Name:CRUZ
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:787-614-3006
Mailing Address - Street 1:SENDEROS DEL RIO 860
Mailing Address - Street 2:CARR.175 APT. 1406
Mailing Address - City:SAN JUAN
Mailing Address - State:PR
Mailing Address - Zip Code:00926
Mailing Address - Country:US
Mailing Address - Phone:787-614-3006
Mailing Address - Fax:787-545-2543
Practice Address - Street 1:SENDEROS DEL RIO 860
Practice Address - Street 2:CARR.175 APT. 1406
Practice Address - City:SAN JUAN
Practice Address - State:PR
Practice Address - Zip Code:00926
Practice Address - Country:US
Practice Address - Phone:787-614-3006
Practice Address - Fax:787-545-2543
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-07-31
Last Update Date:2014-07-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR9855320800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes320800000XResidential Treatment FacilitiesCommunity Based Residential Treatment Facility, Mental Illness