Provider Demographics
NPI:1770762155
Name:INSTITUCION DON GERMAN CARABALLO MOJICA, INC
Entity type:Organization
Organization Name:INSTITUCION DON GERMAN CARABALLO MOJICA, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:WILLIAM
Authorized Official - Middle Name:
Authorized Official - Last Name:CARABALLO ALEMANY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:787-873-0079
Mailing Address - Street 1:HC 9 BOX 5948
Mailing Address - Street 2:
Mailing Address - City:SABANA GRANDE
Mailing Address - State:PR
Mailing Address - Zip Code:00637-9622
Mailing Address - Country:US
Mailing Address - Phone:787-873-0079
Mailing Address - Fax:787-873-0079
Practice Address - Street 1:CARR.369 KM. 2.2 INT. BO. CERRO GORDO
Practice Address - Street 2:
Practice Address - City:SABANA GRANDE
Practice Address - State:PR
Practice Address - Zip Code:00637
Practice Address - Country:US
Practice Address - Phone:787-873-0079
Practice Address - Fax:787-873-0079
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-11-01
Last Update Date:2007-11-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR310400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility