Provider Demographics
NPI:1982903191
Name:ALIANZA SICOCOCIAL DE PUERTO RICO
Entity Type:Organization
Organization Name:ALIANZA SICOCOCIAL DE PUERTO RICO
Other - Org Name:CENTRO DE AYUDA PSICOSOCIAL DEL ESTE ALIANA SICOSOCIAL DE PUERTO RICO
Other - Org Type:Doing Business As
Authorized Official - Title/Position:VICE PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:MANUEL
Authorized Official - Middle Name:ANTONIO
Authorized Official - Last Name:COSME
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:787-685-5074
Mailing Address - Street 1:PO BOX 36758
Mailing Address - Street 2:
Mailing Address - City:SAN JAUN
Mailing Address - State:PR
Mailing Address - Zip Code:00936-7587
Mailing Address - Country:US
Mailing Address - Phone:787-232-5583
Mailing Address - Fax:787-876-3603
Practice Address - Street 1:CARR. PR 187 KM 11-1
Practice Address - Street 2:RESIDENCIAL YUQUIYA
Practice Address - City:LOIZA
Practice Address - State:PR
Practice Address - Zip Code:00772
Practice Address - Country:US
Practice Address - Phone:787-685-5074
Practice Address - Fax:787-876-3603
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-03-28
Last Update Date:2011-03-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes172V00000XOther Service ProvidersCommunity Health WorkerGroup - Single Specialty