Provider Demographics
NPI:1427502954
Name:LIFE AS A GIFT
Entity type:Organization
Organization Name:LIFE AS A GIFT
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CLINIC SOCIAL WORK
Authorized Official - Prefix:MRS
Authorized Official - First Name:MARISOL
Authorized Official - Middle Name:
Authorized Official - Last Name:GONZALEZ SANTANA
Authorized Official - Suffix:
Authorized Official - Credentials:MWS
Authorized Official - Phone:787-463-1294
Mailing Address - Street 1:O13 CALLE LOS PINOS
Mailing Address - Street 2:
Mailing Address - City:CABO ROJO
Mailing Address - State:PR
Mailing Address - Zip Code:00623-3260
Mailing Address - Country:US
Mailing Address - Phone:787-463-1294
Mailing Address - Fax:
Practice Address - Street 1:O13 CALLE LOS PINOS
Practice Address - Street 2:URB SIERRA LINDA
Practice Address - City:CABO ROJO
Practice Address - State:PR
Practice Address - Zip Code:00623-3260
Practice Address - Country:US
Practice Address - Phone:787-463-1294
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-08-13
Last Update Date:2016-08-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR118201041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty