Provider Demographics
NPI:1598363954
Name:TEEN CHALLENGE DE PUERTO RICO, INC.
Entity type:Organization
Organization Name:TEEN CHALLENGE DE PUERTO RICO, INC.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:BILLER
Authorized Official - Prefix:
Authorized Official - First Name:OLGA
Authorized Official - Middle Name:J
Authorized Official - Last Name:GOMEZ RIVERA
Authorized Official - Suffix:
Authorized Official - Credentials:PMB
Authorized Official - Phone:787-632-2072
Mailing Address - Street 1:PO BOX 4273
Mailing Address - Street 2:
Mailing Address - City:BAYAMON
Mailing Address - State:PR
Mailing Address - Zip Code:00958-1273
Mailing Address - Country:US
Mailing Address - Phone:787-730-6908
Mailing Address - Fax:
Practice Address - Street 1:CARRETERA #2 KM 7.7
Practice Address - Street 2:
Practice Address - City:BAYAMON
Practice Address - State:PR
Practice Address - Zip Code:00958-4273
Practice Address - Country:US
Practice Address - Phone:787-730-6908
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-10-16
Last Update Date:2025-03-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes261QM0850XAmbulatory Health Care FacilitiesClinic/CenterAdult Mental HealthGroup - Single Specialty
Yes324500000XResidential Treatment FacilitiesSubstance Abuse Rehabilitation FacilityGroup - Single Specialty
No103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Single Specialty
No2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatryGroup - Single Specialty
No208D00000XAllopathic & Osteopathic PhysiciansGeneral PracticeGroup - Single Specialty
No251J00000XAgenciesNursing Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR39129800Medicaid