Provider Demographics
NPI:1265759989
Name:CENTRO HOLISTICO DE SALUD MENTAL, INC
Entity type:Organization
Organization Name:CENTRO HOLISTICO DE SALUD MENTAL, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MRS
Authorized Official - First Name:CARMEN
Authorized Official - Middle Name:A
Authorized Official - Last Name:SANJURJO
Authorized Official - Suffix:
Authorized Official - Credentials:MA
Authorized Official - Phone:787-768-7000
Mailing Address - Street 1:5 CALLE IGNACIO ARZUAGA E
Mailing Address - Street 2:CAROLINA PROFESIONAL CENTER
Mailing Address - City:CAROLINA
Mailing Address - State:PR
Mailing Address - Zip Code:00985-6250
Mailing Address - Country:US
Mailing Address - Phone:787-768-7900
Mailing Address - Fax:
Practice Address - Street 1:5 CALLE IGNACIO ARZUAGA E
Practice Address - Street 2:CAROLINA PROFESIONAL CENTER
Practice Address - City:CAROLINA
Practice Address - State:PR
Practice Address - Zip Code:00985-6250
Practice Address - Country:US
Practice Address - Phone:787-768-7900
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-04-21
Last Update Date:2010-04-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR261QM0801X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)