Provider Demographics
NPI:1679105902
Name:SUPER HEROES 5K INC
Entity type:Organization
Organization Name:SUPER HEROES 5K INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTORA EJECUTIVA
Authorized Official - Prefix:MRS
Authorized Official - First Name:SOAMMY
Authorized Official - Middle Name:DELIZ
Authorized Official - Last Name:ACEVEDO
Authorized Official - Suffix:
Authorized Official - Credentials:LCDA
Authorized Official - Phone:787-398-0242
Mailing Address - Street 1:EXT. MARBELLA 66 SEVILLA
Mailing Address - Street 2:
Mailing Address - City:AGUADILLA
Mailing Address - State:PUERTO RICO
Mailing Address - Zip Code:00603
Mailing Address - Country:UM
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:KM 2.1 ROAD 107, AGUADILLA PUERTO RICO
Practice Address - Street 2:BORINQUEN
Practice Address - City:AGUADILLA
Practice Address - State:PR
Practice Address - Zip Code:00603
Practice Address - Country:US
Practice Address - Phone:787-398-0242
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-02-05
Last Update Date:2020-02-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes385HR2060XRespite Care FacilityRespite CareRespite Care, Intellectual and/or Developmental Disabilities, Child