Provider Demographics
NPI:1932712247
Name:IRS HOLISTIC CENTER L.L.C
Entity Type:Organization
Organization Name:IRS HOLISTIC CENTER L.L.C
Other - Org Name:IRS HOLISTIC CENTER L.L.C
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:PROVIDER
Authorized Official - Prefix:
Authorized Official - First Name:IVONNE
Authorized Official - Middle Name:YAMIL
Authorized Official - Last Name:RODRIGUEZ RAMOS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:787-362-4175
Mailing Address - Street 1:570 URB EXT VILLAS DE BUENA VENTURA
Mailing Address - Street 2:
Mailing Address - City:YABUCOA
Mailing Address - State:PR
Mailing Address - Zip Code:00767-0000
Mailing Address - Country:US
Mailing Address - Phone:787-362-4175
Mailing Address - Fax:787-767-0210
Practice Address - Street 1:CALLE SERGIO PENA ALMODOVAR 103
Practice Address - Street 2:
Practice Address - City:HUMACAO
Practice Address - State:PR
Practice Address - Zip Code:00791-3655
Practice Address - Country:US
Practice Address - Phone:787-362-4175
Practice Address - Fax:787-767-0210
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-08-26
Last Update Date:2022-05-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistGroup - Multi-Specialty
No103TB0200XBehavioral Health & Social Service ProvidersPsychologistCognitive & BehavioralGroup - Multi-Specialty
No235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language PathologistGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR1265789861OtherNPI