Basic Information
| Provider Information | |||||||||
| NPI: | 1578006300 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | PUERTO RICAN FAMILY INSTITUTE, INC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 145 W 15TH ST | ||||||||
| Address2: | 2ND FLOOR | ||||||||
| City: | NEW YORK | ||||||||
| State: | NY | ||||||||
| PostalCode: | 100116701 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2129246320 | ||||||||
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| Practice Location | |||||||||
| Address1: | 145 W 15TH ST | ||||||||
| Address2: | 2ND FLOOR | ||||||||
| City: | NEW YORK | ||||||||
| State: | NY | ||||||||
| PostalCode: | 100116701 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2129246320 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 11/28/2016 | ||||||||
| LastUpdateDate: | 11/28/2016 | ||||||||
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| AuthorizedOfficialLastName: | RODRIGUEZ | ||||||||
| AuthorizedOfficialFirstName: | IRAN | ||||||||
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| AuthorizedOfficialTitleorPosition: | CEO | ||||||||
| AuthorizedOfficialTelephone: | 2129246320 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | MR. | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 251S00000X | 6758101A | NY | N | Agencies | Community/Behavioral Health | 251S00000X | 6758102A | NY | N | Agencies | Community/Behavioral Health | 315P00000X | 06482440 | NY | N | Nursing & Custodial Care Facilities | Intermediate Care Facility, Mentally Retarded | 251S00000X | 6758110A | NY | Y | Agencies | Community/Behavioral Health |
ID Information
| ID | Type | State | Issuer | Description | 02999411 | 05 | NY | MEDICAID | 00244880 | 05 | NY | MEDICAID | 02999379 | 05 | NY | MEDICAID | 02999420 | 05 | NY | MEDICAID | 001113304 | 05 | NY | MEDICAID | 00357126 | 05 | NY | MEDICAID | 00357135 | 05 | NY | MEDICAID | 01424217 | 05 | NY | MEDICAID |