Provider Demographics
NPI:1912123969
Name:ADMINISTRACION DE SERVICIOS DE SALUD MENTAL Y CONTRA LA ADICCION
Entity Type:Organization
Organization Name:ADMINISTRACION DE SERVICIOS DE SALUD MENTAL Y CONTRA LA ADICCION
Other - Org Name:CLINICA DE TRATAMIENTO INTEGRAL ASISTIDO CON MEDICAMENTOS DE CAYEY
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:DIRECTOR DE FACTURACION
Authorized Official - Prefix:
Authorized Official - First Name:JIMMY
Authorized Official - Middle Name:BAEZ
Authorized Official - Last Name:SALGADO
Authorized Official - Suffix:
Authorized Official - Credentials:SR
Authorized Official - Phone:787-763-7575
Mailing Address - Street 1:PO BOX 607087
Mailing Address - Street 2:
Mailing Address - City:BAYAMON
Mailing Address - State:PR
Mailing Address - Zip Code:00960-7087
Mailing Address - Country:US
Mailing Address - Phone:787-763-7575
Mailing Address - Fax:
Practice Address - Street 1:TO AVE. JOSE DE DIEGO #392 OESTE
Practice Address - Street 2:
Practice Address - City:CAYEY
Practice Address - State:PR
Practice Address - Zip Code:00736
Practice Address - Country:US
Practice Address - Phone:787-763-7575
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-18
Last Update Date:2022-07-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR261QM2800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM2800XAmbulatory Health Care FacilitiesClinic/CenterMethadone