Provider Demographics
NPI:1538585666
Name:INTEGRATED HEALTHCARE CENTER,INC
Entity type:Organization
Organization Name:INTEGRATED HEALTHCARE CENTER,INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENTE
Authorized Official - Prefix:MS
Authorized Official - First Name:EDNA
Authorized Official - Middle Name:VAZQUEZ
Authorized Official - Last Name:GORDIS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:787-406-8932
Mailing Address - Street 1:PO BOX 9023879
Mailing Address - Street 2:
Mailing Address - City:SAN JUAN
Mailing Address - State:PR
Mailing Address - Zip Code:00902-3879
Mailing Address - Country:US
Mailing Address - Phone:787-722-9595
Mailing Address - Fax:
Practice Address - Street 1:1551 CALLE VICTORIA
Practice Address - Street 2:
Practice Address - City:SANTURCE
Practice Address - State:PR
Practice Address - Zip Code:00912-3123
Practice Address - Country:US
Practice Address - Phone:787-724-6063
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-03-13
Last Update Date:2014-06-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR000531231H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologistGroup - Multi-Specialty