Provider Demographics
NPI:1750592317
Name:INICIATIVA COMUNITARIA, INC
Entity type:Organization
Organization Name:INICIATIVA COMUNITARIA, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:JOSE
Authorized Official - Middle Name:ANTONIO
Authorized Official - Last Name:VARGAS
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:787-250-8629
Mailing Address - Street 1:61 CALLE QUISQUEYA
Mailing Address - Street 2:CHILE STREET CORNER
Mailing Address - City:HATO REY
Mailing Address - State:PR
Mailing Address - Zip Code:00917-1202
Mailing Address - Country:US
Mailing Address - Phone:787-250-8629
Mailing Address - Fax:787-753-4454
Practice Address - Street 1:1196 CALLE TOSCANIA
Practice Address - Street 2:VILLA CAPRI
Practice Address - City:RIO PIEDRAS
Practice Address - State:PR
Practice Address - Zip Code:00924-5055
Practice Address - Country:US
Practice Address - Phone:787-283-1520
Practice Address - Fax:787-283-1520
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-25
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR07B0282261QC1500X
PRBH8756314324500000X
PRBH8756299324500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered261QC1500XAmbulatory Health Care FacilitiesClinic/CenterCommunity Health
Not Answered324500000XResidential Treatment FacilitiesSubstance Abuse Rehabilitation Facility