Healthcare Provider Details

I. General information

NPI: 1992868707
Provider Name (Legal Business Name): POST ACUTE MEDICAL OUTPATIENT CLINICS LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/19/2006
Last Update Date: 11/05/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

239 PARK ROAD 5091
GONZALES TX
78629
US

IV. Provider business mailing address

1828 GOOD HOPE RD SUITE 102
ENOLA PA
17025-1233
US

V. Phone/Fax

Practice location:
  • Phone: 830-672-6595
  • Fax: 830-672-7446
Mailing address:
  • Phone: 717-731-9660
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code320700000X
TaxonomyPhysical Disabilities Residential Treatment Facility
License Number000702
License Number StateTX

VIII. Authorized Official

Name: MR. ANTHONY F MISITANO
Title or Position: PRESIDENT
Credential:
Phone: 717-731-9660