MEDICARE: TEXAS LAUREL RIDGE HOSPITAL LP

Medicare Provider Information

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	323P00000X	Psychiatric Residential Treatment Facility	827024	TX
2	283Q00000X	Psychiatric Hospital	000723	TX

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
3	HH6534	OTHER	TX	BC PARTIAL PIN
4	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
5	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
6	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
7	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
8	HH3825	OTHER	TX	BC CD PIN
9	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
10	HH0825	OTHER	TX	BC ACUTE PIN
11	119465	OTHER	PA	CBH PIN
12	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
13	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
14	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
15	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
16	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
17	HH6623	OTHER	TX	BC RTC PIN

NPI Number	:	1043280951
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	TEXAS LAUREL RIDGE HOSPITAL LP

Provider Business Mailing Address
First Line	:	17720 CORPORATE WOODS DR
Second Line	:
City	:	SAN ANTONIO
State	:	TX
Zip	:	78259-3500
Country	:	US
Telephone Number	:	210-491-9400
Fax Number	:	210-491-3517

Provider Business Practice Location Address
First Line	:	17720 CORPORATE WOODS DR
Second Line	:
City	:	SAN ANTONIO
State	:	TX
Zip	:	78259-3500
Country	:	US
Telephone Number	:	210-491-9400
Fax Number	:	210-491-3517

Authorized Official
Title or Position	:	SRVP CFO
Name	:	STEVE FILTON
Credential	:
Telephone Number	:	610-768-3300

Provider Enumeration Date	:	01/24/2006
Last Update Date	:	10/28/2015

211 CALLE MORSE
ARROYO, PR
00714-2350

Practice Phone: 787-839-3980
Practice Fax: 787-271-2515