Provider Demographics
NPI:1972565240
Name:TAKECARE INSURANCE COMPANY INC.
Entity type:Organization
Organization Name:TAKECARE INSURANCE COMPANY INC.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CSG ADMINISTRATOR/CONTROLLER
Authorized Official - Prefix:MR
Authorized Official - First Name:LUCIO ALBERTO
Authorized Official - Middle Name:VILLAMAYOR
Authorized Official - Last Name:ALMIRA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:671-646-6956
Mailing Address - Street 1:P.O. BOX 6578
Mailing Address - Street 2:
Mailing Address - City:TAMUNING
Mailing Address - State:GU
Mailing Address - Zip Code:96931-6578
Mailing Address - Country:US
Mailing Address - Phone:671-646-6956
Mailing Address - Fax:671-647-3556
Practice Address - Street 1:548 S MARINE CORPS. DR
Practice Address - Street 2:
Practice Address - City:TAMUNING
Practice Address - State:GU
Practice Address - Zip Code:96913
Practice Address - Country:US
Practice Address - Phone:671-646-6956
Practice Address - Fax:671-647-3556
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:TAKECARE INSURANCE CO. INC.
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2006-04-03
Last Update Date:2023-08-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GU261QM1300X
GU1141450302R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes302R00000XManaged Care OrganizationsHealth Maintenance Organization
No261QM1300XAmbulatory Health Care FacilitiesClinic/CenterMulti-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
GUH55053Medicare PIN