Healthcare Provider Details

I. General information

NPI: 1265058010
Provider Name (Legal Business Name): INBETWEEN LIVING REHABILITATION CENTER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/17/2020
Last Update Date: 06/17/2020
Certification Date: 06/17/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9511 PERRIN BEITEL RD APT 205
SAN ANTONIO TX
78217-3538
US

IV. Provider business mailing address

9511 PERRIN BEITEL RD APT 205
SAN ANTONIO TX
78217-3538
US

V. Phone/Fax

Practice location:
  • Phone: 210-238-4427
  • Fax:
Mailing address:
  • Phone: 210-238-4427
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code103TM1800X
TaxonomyIntellectual & Developmental Disabilities Psychologist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code251V00000X
TaxonomyVoluntary or Charitable Agency
License Number
License Number State
# 4
Primary TaxonomyY
Taxonomy Code103TR0400X
TaxonomyRehabilitation Psychologist
License Number
License Number State

VIII. Authorized Official

Name: DYNASTY ROCHELLE HOLLAND
Title or Position: OWNER
Credential:
Phone: 210-269-9715