Provider Demographics
NPI:1396415865
Name:NEUROACTIVO MEMORY CARE SERVICES LLC.
Entity type:Organization
Organization Name:NEUROACTIVO MEMORY CARE SERVICES LLC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MRS
Authorized Official - First Name:YAELIS
Authorized Official - Middle Name:CORAL
Authorized Official - Last Name:ACEVEDO
Authorized Official - Suffix:
Authorized Official - Credentials:MPH-GERO, CDS, PTA
Authorized Official - Phone:939-265-8370
Mailing Address - Street 1:1206 CALLE 62 SE
Mailing Address - Street 2:
Mailing Address - City:SAN JUAN
Mailing Address - State:PR
Mailing Address - Zip Code:00921-3134
Mailing Address - Country:US
Mailing Address - Phone:787-689-4245
Mailing Address - Fax:
Practice Address - Street 1:CARR. #683 KM. 0.1
Practice Address - Street 2:
Practice Address - City:ARECIBO
Practice Address - State:PR
Practice Address - Zip Code:00612
Practice Address - Country:US
Practice Address - Phone:787-689-4245
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-09-16
Last Update Date:2021-09-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes311500000XNursing & Custodial Care FacilitiesAlzheimer Center (Dementia Center)