Provider Demographics
NPI:1578902193
Name:PROGRAMA DE SERVICIOS DE SALUD CORRECCIONAL
Entity Type:Organization
Organization Name:PROGRAMA DE SERVICIOS DE SALUD CORRECCIONAL
Other - Org Name:PROGRAMA DE SALUD CORRECCIONAL
Other - Org Type:Other Name
Authorized Official - Title/Position:DIRECTOR OF OPERATIONS
Authorized Official - Prefix:MR
Authorized Official - First Name:BILL
Authorized Official - Middle Name:ANTHONY
Authorized Official - Last Name:RESTO TORRES
Authorized Official - Suffix:
Authorized Official - Credentials:MHSA
Authorized Official - Phone:787-774-3344
Mailing Address - Street 1:METRO OFFICE PARK
Mailing Address - Street 2:18 CALLE 1 STE 400
Mailing Address - City:GUAYNABO
Mailing Address - State:PR
Mailing Address - Zip Code:00968-1704
Mailing Address - Country:US
Mailing Address - Phone:787-774-3344
Mailing Address - Fax:787-774-6253
Practice Address - Street 1:METRO OFFICE PARK
Practice Address - Street 2:18 CALLE 1 STE 400
Practice Address - City:GUAYNABO
Practice Address - State:PR
Practice Address - Zip Code:00968-1704
Practice Address - Country:US
Practice Address - Phone:787-774-3344
Practice Address - Fax:787-774-6253
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-06-17
Last Update Date:2013-06-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR10-CNCNUM.05-298283Q00000X, 310500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes283Q00000XHospitalsPsychiatric Hospital
No310500000XNursing & Custodial Care FacilitiesIntermediate Care Facility, Mental Illness