1538104112 NPI number — POST ACUTE MEDICAL AT SAN ANTONIO LLC

Table of content: (NPI 1538104112)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1538104112 NPI number — POST ACUTE MEDICAL AT SAN ANTONIO LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
POST ACUTE MEDICAL AT SAN ANTONIO LLC
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:
1538104112
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
12/20/2016
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1828 GOOD HOPE ROAD
Provider Second Line Business Mailing Address:
SUITE 102
Provider Business Mailing Address City Name:
ENOLA
Provider Business Mailing Address State Name:
PA
Provider Business Mailing Address Postal Code:
17019-1203
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
717-731-9660
Provider Business Mailing Address Fax Number:
210-829-8741

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
7616 CULEBRA RD
Provider Second Line Business Practice Location Address:
SUITE 115
Provider Business Practice Location Address City Name:
SAN ANTONIO
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
78251-1476
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
210-682-2346
Provider Business Practice Location Address Fax Number:
210-681-7192
Provider Enumeration Date:
06/18/2006

Additional Information

Authorized Official

Authorized Official Last Name:
MISITANO
Authorized Official First Name:
ANTHONY
Authorized Official Middle Name:
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
717-731-9660

Provider Taxonomy Codes

  • Taxonomy code: 261QR0400X , with the licence number:  000643 , 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)

  • Identifier: 0211724-01 , issued by the state of ( TX ) . This identifiers is of the category "MEDICAID".




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