Provider Demographics
NPI:1902282247
Name:INICIATIVA COMUNITARIA DE INVESTIGACION
Entity Type:Organization
Organization Name:INICIATIVA COMUNITARIA DE INVESTIGACION
Other - Org Name:COMPROMISO DE VIDA I
Other - Org Type:Doing Business As
Authorized Official - Title/Position:COORDINATOR
Authorized Official - Prefix:DR
Authorized Official - First Name:DIANA
Authorized Official - Middle Name:CAMACHO
Authorized Official - Last Name:VARGAS
Authorized Official - Suffix:
Authorized Official - Credentials:PSYD
Authorized Official - Phone:787-283-1520
Mailing Address - Street 1:PO BOX 366535
Mailing Address - Street 2:URBANIZACION VILLA CAPRI CALLE TOSCANIA 1196
Mailing Address - City:SAN JUAN
Mailing Address - State:PR
Mailing Address - Zip Code:00926-6535
Mailing Address - Country:US
Mailing Address - Phone:787-283-1520
Mailing Address - Fax:
Practice Address - Street 1:CALLE TOSCANIA #1196
Practice Address - Street 2:URB. VILLA CAPRI
Practice Address - City:SAN JUAN
Practice Address - State:PR
Practice Address - Zip Code:00924
Practice Address - Country:US
Practice Address - Phone:787-283-1520
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-08-10
Last Update Date:2015-08-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes324500000XResidential Treatment FacilitiesSubstance Abuse Rehabilitation Facility