Provider Demographics
NPI:1588965016
Name:ADVANCED BEHAVIORAL CENTER, INC.
Entity type:Organization
Organization Name:ADVANCED BEHAVIORAL CENTER, INC.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:MIGUEL
Authorized Official - Middle Name:H
Authorized Official - Last Name:CREALES
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:787-841-8855
Mailing Address - Street 1:3181 CALLE MARBELLA
Mailing Address - Street 2:URB. EL MONTE
Mailing Address - City:PONCE
Mailing Address - State:PR
Mailing Address - Zip Code:00716-4809
Mailing Address - Country:US
Mailing Address - Phone:787-841-8855
Mailing Address - Fax:787-841-8855
Practice Address - Street 1:92 CALLE SOL
Practice Address - Street 2:ESQUINA TORRES
Practice Address - City:PONCE
Practice Address - State:PR
Practice Address - Zip Code:00730-3669
Practice Address - Country:US
Practice Address - Phone:787-841-8855
Practice Address - Fax:787-841-8855
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-11-15
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR261Q00000X, 261QM0850X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0850XAmbulatory Health Care FacilitiesClinic/CenterAdult Mental Health
No261Q00000XAmbulatory Health Care FacilitiesClinic/Center