Provider Demographics
| NPI: | 1356388532 |
|---|---|
| Name: | SOCIEDAD DE EDUCACION Y REHABILITACION SER DE PUERTO RICO INC |
| Entity type: | Organization |
| Organization Name: | SOCIEDAD DE EDUCACION Y REHABILITACION SER DE PUERTO RICO INC |
| Other - Org Name: | <UNAVAIL> |
| Other - Org Type: | |
| Authorized Official - Title/Position: | PRESIDENT AND CEO |
| Authorized Official - Prefix: | MS |
| Authorized Official - First Name: | NILDA |
| Authorized Official - Middle Name: | ROSA |
| Authorized Official - Last Name: | MORALES |
| Authorized Official - Suffix: | |
| Authorized Official - Credentials: | |
| Authorized Official - Phone: | 787-767-6710 |
| Mailing Address - Street 1: | PO BOX 364189 |
| Mailing Address - Street 2: | |
| Mailing Address - City: | SAN JUAN |
| Mailing Address - State: | PR |
| Mailing Address - Zip Code: | 00936-4189 |
| Mailing Address - Country: | US |
| Mailing Address - Phone: | 787-767-6710 |
| Mailing Address - Fax: | 787-758-0950 |
| Practice Address - Street 1: | 500 CALLE BAEZ |
| Practice Address - Street 2: | URB. PEREZ MORIS |
| Practice Address - City: | SAN JUAN |
| Practice Address - State: | PR |
| Practice Address - Zip Code: | 00917-5020 |
| Practice Address - Country: | US |
| Practice Address - Phone: | 787-767-6710 |
| Practice Address - Fax: | 787-758-0950 |
| EIN: | <UNAVAIL> |
| Is Organization Subpart?: | No |
| Parent Organization LBN: | |
| Parent Organization TIN: | |
| Enumeration Date: | 2006-05-31 |
| Last Update Date: | 2024-03-11 |
| Deactivation Date: | |
| Deactivation Code: | |
| Reactivation Date: |
Provider Taxonomies
| Primary? | Code | Type | Classification | Specialization | Group |
|---|---|---|---|---|---|
| Yes | 208100000X | Allopathic & Osteopathic Physicians | Physical Medicine & Rehabilitation | Group - Single Specialty | |
| No | 2080P0216X | Allopathic & Osteopathic Physicians | Pediatrics | Pediatric Rheumatology | Group - Single Specialty |
| No | 103T00000X | Behavioral Health & Social Service Providers | Psychologist | Group - Single Specialty | |
| No | 103TC0700X | Behavioral Health & Social Service Providers | Psychologist | Clinical | Group - Single Specialty |
| No | 103TC2200X | Behavioral Health & Social Service Providers | Psychologist | Clinical Child & Adolescent | Group - Single Specialty |
| No | 104100000X | Behavioral Health & Social Service Providers | Social Worker | Group - Single Specialty | |
| No | 207XP3100X | Allopathic & Osteopathic Physicians | Orthopaedic Surgery | Pediatric Orthopaedic Surgery | Group - Single Specialty |
| No | 235Z00000X | Speech, Language and Hearing Service Providers | Speech-Language Pathologist | Group - Single Specialty | |
| No | 261QM0801X | Ambulatory Health Care Facilities | Clinic/Center | Mental Health (Including Community Mental Health Center) | Group - Single Specialty |
| No | 261QP2000X | Ambulatory Health Care Facilities | Clinic/Center | Physical Therapy | Group - Single Specialty |
| No | 2084N0402X | Allopathic & Osteopathic Physicians | Psychiatry & Neurology | Neurology with Special Qualifications in Child Neurology | Group - Single Specialty |
| No | 225X00000X | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Occupational Therapist | Group - Single Specialty |
Provider Identifiers
| State | Identifier ID | ID Type | Issuer |
|---|---|---|---|
| PR | 0029109 | Medicare ID - Type Unspecified |
