Provider Demographics
NPI:1538344130
Name:CENTRO DE REHABILITACION LA MONTANA, C.S.P.
Entity type:Organization
Organization Name:CENTRO DE REHABILITACION LA MONTANA, C.S.P.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:ANGEL
Authorized Official - Middle Name:A
Authorized Official - Last Name:ADORNO
Authorized Official - Suffix:
Authorized Official - Credentials:PT
Authorized Official - Phone:787-884-8923
Mailing Address - Street 1:PO BOX 2173
Mailing Address - Street 2:
Mailing Address - City:MANATI
Mailing Address - State:PR
Mailing Address - Zip Code:00674
Mailing Address - Country:US
Mailing Address - Phone:787-884-8923
Mailing Address - Fax:787-854-4476
Practice Address - Street 1:ELIOT VELEZ ST J-20
Practice Address - Street 2:
Practice Address - City:MANATI
Practice Address - State:PR
Practice Address - Zip Code:00674-0001
Practice Address - Country:US
Practice Address - Phone:787-884-8923
Practice Address - Fax:787-854-4476
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-01-02
Last Update Date:2008-01-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR989261Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR0050105Medicare PIN