Provider Demographics
NPI:1134115587
Name:RESIDENCIAL NINOS Y ADOLESCENTES/SERAS
Entity type:Organization
Organization Name:RESIDENCIAL NINOS Y ADOLESCENTES/SERAS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:COORDINATOR DE FACTURACION Y COBRO
Authorized Official - Prefix:
Authorized Official - First Name:JEARIM
Authorized Official - Middle Name:T
Authorized Official - Last Name:RIVERA PIMENTEL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:787-763-7575
Mailing Address - Street 1:PO BOX 607087
Mailing Address - Street 2:
Mailing Address - City:BAYAMON
Mailing Address - State:PR
Mailing Address - Zip Code:00960
Mailing Address - Country:US
Mailing Address - Phone:787-763-7575
Mailing Address - Fax:787-995-5167
Practice Address - Street 1:AVE LAUREL #100, URB SANTA JUANITA
Practice Address - Street 2:
Practice Address - City:BAYAMON
Practice Address - State:PR
Practice Address - Zip Code:00956-4816
Practice Address - Country:US
Practice Address - Phone:787-763-7575
Practice Address - Fax:787-995-5167
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-09-21
Last Update Date:2025-08-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR3261QM0801X, 283Q00000X
103TA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TA0400XBehavioral Health & Social Service ProvidersPsychologistAddiction (Substance Use Disorder)Group - Multi-Specialty
No261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)
No283Q00000XHospitalsPsychiatric Hospital
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR2437-5OtherAMPR
PR43348109OtherCOSVI
PR6-6399OtherCRUZ AZUL
PR9600116OtherHUMANA
PR660452116-11OtherGOLDEN CROSS
PR039736000Medicaid
PR222049OtherPREFERRED HEALTH
PR660433481-004OtherMCS
PR1529OtherAPS