Provider Demographics
NPI:1932359411
Name:MIGRANT HEALTH CENTER, INC.
Entity Type:Organization
Organization Name:MIGRANT HEALTH CENTER, INC.
Other - Org Name:MIGRANT HEALTH CENTER, INC.
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:DIRECTOR EJECUTIVO
Authorized Official - Prefix:MR
Authorized Official - First Name:REYNALDO
Authorized Official - Middle Name:SERRANO
Authorized Official - Last Name:CARABALLO
Authorized Official - Suffix:
Authorized Official - Credentials:MR
Authorized Official - Phone:787-805-7360
Mailing Address - Street 1:PO BOX 190
Mailing Address - Street 2:
Mailing Address - City:MAYAGUEZ
Mailing Address - State:PR
Mailing Address - Zip Code:00681-0190
Mailing Address - Country:US
Mailing Address - Phone:787-805-7360
Mailing Address - Fax:
Practice Address - Street 1:CALLE RAMON E. BETANCES 392 SUR
Practice Address - Street 2:
Practice Address - City:MAYAGUEZ
Practice Address - State:PR
Practice Address - Zip Code:00680
Practice Address - Country:US
Practice Address - Phone:787-805-7360
Practice Address - Fax:787-834-1924
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-09-22
Last Update Date:2008-09-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental
Provider Identifiers
StateIdentifier IDID TypeIssuer
PRNUM PATRONALOther40845