Basic Information
| Provider Information | |||||||||
| NPI: | 1225266059 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | SOUTHWEST HEALTH CORP | ||||||||
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| OtherOrganizationName: | HOSPITAL METROPOLITANO PSIQUIATRICO DE CABO ROJO | ||||||||
| OtherOrganizationType: | 3 | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 910 | ||||||||
| Address2: | |||||||||
| City: | CABO ROJO | ||||||||
| State: | PR | ||||||||
| PostalCode: | 006230910 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7878061687 | ||||||||
| FaxNumber: | 7878061686 | ||||||||
| Practice Location | |||||||||
| Address1: | AVE. GONZALEZ CLEMENTE #445, BO. GUANAJIBO | ||||||||
| Address2: | EDIF. VAL HARBOR, SUITE 105 | ||||||||
| City: | MAYAGUEZ | ||||||||
| State: | PR | ||||||||
| PostalCode: | 00681 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7878061687 | ||||||||
| FaxNumber: | 7878061686 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/01/2009 | ||||||||
| LastUpdateDate: | 03/17/2022 | ||||||||
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| AuthorizedOfficialLastName: | ORTIZ PAGAN | ||||||||
| AuthorizedOfficialFirstName: | GIOVANNI | ||||||||
| AuthorizedOfficialMiddleName: | EZEQUIEL | ||||||||
| AuthorizedOfficialTitleorPosition: | DIRECTOR EJECUTIVO | ||||||||
| AuthorizedOfficialTelephone: | 7878512025 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialCredential: | MHSA | ||||||||
| NPICertificationDate: | 03/17/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 261QM0801X | 70 | PR | Y | Ambulatory Health Care Facilities | Clinic/Center | Mental Health (Including Community Mental Health Center) |
No ID Information.