Provider Demographics
NPI:1295177269
Name:EUREKA MENTAL HEALTH & WELLNES CENTER
Entity type:Organization
Organization Name:EUREKA MENTAL HEALTH & WELLNES CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DHIEF EXECUTIVE OFFICER
Authorized Official - Prefix:DR
Authorized Official - First Name:SONIA
Authorized Official - Middle Name:MARIA
Authorized Official - Last Name:MEDINA
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:787-427-4722
Mailing Address - Street 1:PO BOX 30500
Mailing Address - Street 2:PMB 247
Mailing Address - City:MANATI
Mailing Address - State:PR
Mailing Address - Zip Code:00674
Mailing Address - Country:US
Mailing Address - Phone:787-427-4722
Mailing Address - Fax:787-854-0650
Practice Address - Street 1:PR-4494 KM 2.6
Practice Address - Street 2:PLAZA CAMUY BUILDING
Practice Address - City:CAMUY
Practice Address - State:PR
Practice Address - Zip Code:00627
Practice Address - Country:US
Practice Address - Phone:787-427-4722
Practice Address - Fax:787-854-0650
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-07-19
Last Update Date:2013-07-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR005177261QM0855X, 261QM0850X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0850XAmbulatory Health Care FacilitiesClinic/CenterAdult Mental Health
No261QM0855XAmbulatory Health Care FacilitiesClinic/CenterAdolescent and Children Mental Health