Provider Demographics
NPI:1770786410
Name:SUBSTANCE ABUSE AND MENTAL HEALTH SERVICES ADMINISTRATION
Entity type:Organization
Organization Name:SUBSTANCE ABUSE AND MENTAL HEALTH SERVICES ADMINISTRATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:GENERAL NURSE SUPERVISOR
Authorized Official - Prefix:MISS
Authorized Official - First Name:CARMEN
Authorized Official - Middle Name:B
Authorized Official - Last Name:AVINO
Authorized Official - Suffix:
Authorized Official - Credentials:RN
Authorized Official - Phone:1787-786-3620
Mailing Address - Street 1:CALLE EMANUELLI
Mailing Address - Street 2:205 APT.1
Mailing Address - City:SAN JUAN
Mailing Address - State:PR
Mailing Address - Zip Code:00917-4100
Mailing Address - Country:US
Mailing Address - Phone:787-783-0750
Mailing Address - Fax:787-781-8129
Practice Address - Street 1:AVE LAUREL SANTA JUANITA
Practice Address - Street 2:HOSP DR RAMON RUIZ ARNAU
Practice Address - City:BAYAMON
Practice Address - State:PR
Practice Address - Zip Code:00920-3860
Practice Address - Country:US
Practice Address - Phone:178-778-6362
Practice Address - Fax:787-781-8129
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-06-08
Last Update Date:2008-09-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR15500322D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes322D00000XResidential Treatment FacilitiesResidential Treatment Facility, Emotionally Disturbed Children