Provider Demographics
NPI:1447291554
Name:REHABILITACION PUERTORRIQUENA DEL CARIBE
Entity type:Organization
Organization Name:REHABILITACION PUERTORRIQUENA DEL CARIBE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MRS
Authorized Official - First Name:NINNA
Authorized Official - Middle Name:S
Authorized Official - Last Name:RIVERA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:787-757-6636
Mailing Address - Street 1:PO BOX 999
Mailing Address - Street 2:
Mailing Address - City:RIO GRANDE
Mailing Address - State:PR
Mailing Address - Zip Code:00745-0999
Mailing Address - Country:US
Mailing Address - Phone:757-757-6636
Mailing Address - Fax:757-256-1358
Practice Address - Street 1:CARR 188 KM 1.5 PARCELAS NUEVAS
Practice Address - Street 2:BO SAN ISIDRO
Practice Address - City:CANOVANAS
Practice Address - State:PR
Practice Address - Zip Code:00729
Practice Address - Country:US
Practice Address - Phone:787-757-6636
Practice Address - Fax:787-256-1356
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-09
Last Update Date:2010-03-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR409320700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes320700000XResidential Treatment FacilitiesResidential Treatment Facility, Physical Disabilities
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR=========OtherEIN
PR=========OtherEIN