Healthcare Provider Details

I. General information

NPI: 1578902193
Provider Name (Legal Business Name): PROGRAMA DE SERVICIOS DE SALUD CORRECCIONAL
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/17/2013
Last Update Date: 06/17/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

METRO OFFICE PARK 18 CALLE 1 STE 400
GUAYNABO PR
00968-1704
US

IV. Provider business mailing address

METRO OFFICE PARK 18 CALLE 1 STE 400
GUAYNABO PR
00968-1704
US

V. Phone/Fax

Practice location:
  • Phone: 787-774-3344
  • Fax: 787-774-6253
Mailing address:
  • Phone: 787-774-3344
  • Fax: 787-774-6253

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code283Q00000X
TaxonomyPsychiatric Hospital
License Number10-CNCNUM.05-298
License Number StatePR
# 2
Primary TaxonomyN
Taxonomy Code310500000X
TaxonomyMental Illness Intermediate Care Facility
License Number10-CNCNUM.05-298
License Number StatePR

VIII. Authorized Official

Name: MR. BILL ANTHONY RESTO TORRES
Title or Position: DIRECTOR OF OPERATIONS
Credential: MHSA
Phone: 787-774-3344