Provider Demographics
NPI:1780791814
Name:MUNICIPIO DE SABANA GRANDE
Entity type:Organization
Organization Name:MUNICIPIO DE SABANA GRANDE
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MR
Authorized Official - First Name:ULISES
Authorized Official - Middle Name:
Authorized Official - Last Name:MENDEZ
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:787-873-1755
Mailing Address - Street 1:301 AVE 5 DE DICIEMBRE
Mailing Address - Street 2:
Mailing Address - City:SABANA GRANDE
Mailing Address - State:PR
Mailing Address - Zip Code:00637-2416
Mailing Address - Country:US
Mailing Address - Phone:787-873-1755
Mailing Address - Fax:787-873-2145
Practice Address - Street 1:CARR. 102 KM 39.1
Practice Address - Street 2:
Practice Address - City:SABANA GRANDE
Practice Address - State:PR
Practice Address - Zip Code:00637-2416
Practice Address - Country:US
Practice Address - Phone:787-873-1755
Practice Address - Fax:787-873-2145
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-24
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR261Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center
Provider Identifiers
StateIdentifier IDID TypeIssuer
2-2063Medicare PIN