MEDICARE: MISSION VISTA BEHAVIORAL HEALTH SERVICES, INC.

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	283Q00000X	Psychiatric Hospital

General Provider Information

NPI Number	:	1992706162
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MISSION VISTA BEHAVIORAL HEALTH SERVICES, INC.

Provider Business Mailing Address
First Line	:	14747 JONES MALTSBERGER RD
Second Line	:
City	:	SAN ANTONIO
State	:	TX
Zip	:	78247-3713
Country	:	US
Telephone Number	:	210-497-0004
Fax Number	:	210-572-1447

Provider Business Practice Location Address
First Line	:	14747 JONES MALTSBERGER RD
Second Line	:
City	:	SAN ANTONIO
State	:	TX
Zip	:	78247-3713
Country	:	US
Telephone Number	:	210-497-0004
Fax Number	:	210-572-1447

Authorized Official
Title or Position	:	DIRECTOR OF PATIENT ACCOUNTING
Name	:	MRS. LISA WARNER
Credential	:
Telephone Number	:	210-679-2157

Provider Enumeration Date	:	08/09/2005
Last Update Date	:	07/30/2007

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