Provider Demographics
NPI:1649560111
Name:CORRECTIONAL HEALTH SERVICES CORPORATION
Entity Type:Organization
Organization Name:CORRECTIONAL HEALTH SERVICES CORPORATION
Other - Org Name:CHSC
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
Authorized Official - Suffix:
Authorized Official - Credentials:MHSA
Authorized Official - Phone:787-774-3344
Mailing Address - Street 1:CALLE 1 LOTE 18
Mailing Address - Street 2:SUITE 400 METRO OFFICE PARK
Mailing Address - City:GUAYNABO
Mailing Address - State:PR
Mailing Address - Zip Code:00968-1768
Mailing Address - Country:US
Mailing Address - Phone:787-774-3344
Mailing Address - Fax:787-774-6253
Practice Address - Street 1:CALLE 1 LOTE 18
Practice Address - Street 2:SUITE 400 METRO OFFICE PARK
Practice Address - City:GUAYNABO
Practice Address - State:PR
Practice Address - Zip Code:00968-1768
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:2011-04-18
Last Update Date:2011-04-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
261QP2400X, 310500000X, 313M00000X, 314000000X, 324500000X
PR10-CNCNUM.05-298283Q00000X
PR3336I0012X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2400XAmbulatory Health Care FacilitiesClinic/CenterPrison Health
No283Q00000XHospitalsPsychiatric Hospital
No310500000XNursing & Custodial Care FacilitiesIntermediate Care Facility, Mental Illness
No313M00000XNursing & Custodial Care FacilitiesNursing Facility/Intermediate Care Facility
No314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
No324500000XResidential Treatment FacilitiesSubstance Abuse Rehabilitation Facility
No3336I0012XSuppliersPharmacyInstitutional Pharmacy