Provider Demographics
NPI:1356746572
Name:OPCION DE VIDA ' TU ALTERNATIVA' INC.
Entity type:Organization
Organization Name:OPCION DE VIDA ' TU ALTERNATIVA' INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRACTICE NURSE
Authorized Official - Prefix:MISS
Authorized Official - First Name:MARIA
Authorized Official - Middle Name:ALEJANDRA
Authorized Official - Last Name:RIVERA RIOS
Authorized Official - Suffix:
Authorized Official - Credentials:LPN
Authorized Official - Phone:787-364-1716
Mailing Address - Street 1:437 CALLE FRATERNIDAD
Mailing Address - Street 2:BDA. OBRERA
Mailing Address - City:FAJARDO
Mailing Address - State:PR
Mailing Address - Zip Code:00738-4526
Mailing Address - Country:US
Mailing Address - Phone:787-526-0680
Mailing Address - Fax:
Practice Address - Street 1:437 CALLE FRATERNIDAD
Practice Address - Street 2:BARRIADA OBRERA
Practice Address - City:FAJARDO
Practice Address - State:PR
Practice Address - Zip Code:00738-4526
Practice Address - Country:US
Practice Address - Phone:787-364-1716
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-10-30
Last Update Date:2014-10-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR341545311ZA0620X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes311ZA0620XNursing & Custodial Care FacilitiesCustodial Care FacilityAdult Care Home
Provider Identifiers
StateIdentifier IDID TypeIssuer
PRCLP30010237OtherPROGGRSSIVE, POLIZA DEL SEGURO DEL ESTADO, SEGURO CHOFERIL
PR341545Medicaid
PR341545OtherCORPORATION NUMBER
PRCLP 30010237OtherPOLICY NUMBER
PRCLP 30010237OtherPOLICY NUMBER
PR341545Medicaid