MEDICARE: MILAGRO DISCOVERY HOME AND COMMUNITY HEALTHCARE SERVICE

Medicare Provider Information

Scope of Practice

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

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	261QA0600X	Adult Day Care Clinic/Center	143171	TX
2	251S00000X	Community/Behavioral Health Agency

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1487837316
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MILAGRO DISCOVERY HOME AND COMMUNITY HEALTHCARE SERVICE

Provider Business Mailing Address
First Line	:	PO BOX 760595
Second Line	:
City	:	SAN ANTONIO
State	:	TX
Zip	:	78245-0595
Country	:	US
Telephone Number	:	210-815-1385
Fax Number	:

Provider Business Practice Location Address
First Line	:	6810 BANDERA RD STE 1
Second Line	:
City	:	SAN ANTONIO
State	:	TX
Zip	:	78238-1468
Country	:	US
Telephone Number	:	210-446-4706
Fax Number	:

Authorized Official
Title or Position	:	EXECUTIVE DIRECTOR
Name	:	CARLA EVETTE THOMAS
Credential	:
Telephone Number	:	210-815-1385

Provider Enumeration Date	:	12/13/2007
Last Update Date	:	11/19/2015

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