Healthcare Provider Details

I. General information

NPI: 1861074700
Provider Name (Legal Business Name): WENDYS SENIORCARE CONSULTING, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/21/2021
Last Update Date: 05/11/2021
Certification Date: 04/27/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

13122 QUINLAN RNCH
SAN ANTONIO TX
78253-3421
US

IV. Provider business mailing address

13122 QUINLAN RNCH
SAN ANTONIO TX
78253-3421
US

V. Phone/Fax

Practice location:
  • Phone: 210-837-4196
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code171400000X
TaxonomyHealth & Wellness Coach
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code363LG0600X
TaxonomyGerontology Nurse Practitioner
License Number
License Number State

VIII. Authorized Official

Name: WENDY VAN DYKE
Title or Position: MANAGER
Credential: NP
Phone: 210-837-4196