Provider Demographics
NPI:1295976603
Name:GRUPO DE SERVICIOS FORTALEZA, INC.
Entity type:Organization
Organization Name:GRUPO DE SERVICIOS FORTALEZA, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:JARI
Authorized Official - Middle Name:RAFAEL
Authorized Official - Last Name:MORENO-SANCHEZ
Authorized Official - Suffix:
Authorized Official - Credentials:MSW
Authorized Official - Phone:787-721-7314
Mailing Address - Street 1:PO BOX 9021477
Mailing Address - Street 2:
Mailing Address - City:SAN JUAN
Mailing Address - State:PR
Mailing Address - Zip Code:00902-1477
Mailing Address - Country:US
Mailing Address - Phone:787-721-7314
Mailing Address - Fax:
Practice Address - Street 1:252 CALLE FORTALEZA
Practice Address - Street 2:VIEJO SAN JUAN
Practice Address - City:SAN JUAN
Practice Address - State:PR
Practice Address - Zip Code:00901-1780
Practice Address - Country:US
Practice Address - Phone:787-721-7314
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-03-13
Last Update Date:2009-03-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR84521041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Multi-Specialty