1003111592 NPI number — CLASSIC DRIVE HEALTHCARE AND REHAB

Table of content: LAUREN KACEY STEVENS LMSW (NPI 1285366526)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1003111592 NPI number — CLASSIC DRIVE HEALTHCARE AND REHAB

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
CLASSIC DRIVE HEALTHCARE AND REHAB
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
6
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1003111592
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
03/14/2011
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
8000 IH 10 W
Provider Second Line Business Mailing Address:
SUITE 1500
Provider Business Mailing Address City Name:
SAN ANTONIO
Provider Business Mailing Address State Name:
TX
Provider Business Mailing Address Postal Code:
78230-3802
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
210-525-7993
Provider Business Mailing Address Fax Number:
210-525-7992

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
9922 STATE HWY. 151
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
SAN ANTONIO
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
78251-4554
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
210-525-7993
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
01/14/2011

Additional Information

Authorized Official

Authorized Official Last Name:
CRANK
Authorized Official First Name:
TIMOTHY
Authorized Official Middle Name:
W
Authorized Official Title or Position:
MANAGER
Authorized Official Telephone Number:
210-525-7993

Provider Taxonomy Codes

  • Taxonomy code: 314000000X , registered in the state of TX ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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