Provider Demographics
NPI:1487040267
Name:CDC GROUP SERVICES INC
Entity type:Organization
Organization Name:CDC GROUP SERVICES INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:DELGIA
Authorized Official - Middle Name:
Authorized Official - Last Name:CRUZ
Authorized Official - Suffix:
Authorized Official - Credentials:CPL
Authorized Official - Phone:787-598-4528
Mailing Address - Street 1:PO BOX 893
Mailing Address - Street 2:
Mailing Address - City:JUANA DIAZ
Mailing Address - State:PR
Mailing Address - Zip Code:00795-0893
Mailing Address - Country:US
Mailing Address - Phone:787-598-4528
Mailing Address - Fax:787-837-8668
Practice Address - Street 1:36 CALLE ESTRELLA
Practice Address - Street 2:
Practice Address - City:PONCE
Practice Address - State:PR
Practice Address - Zip Code:00730-3832
Practice Address - Country:US
Practice Address - Phone:787-598-4528
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-04-08
Last Update Date:2015-04-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR4010101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Multi-Specialty