Healthcare Provider Details

I. General information

NPI: 1619216280
Provider Name (Legal Business Name): NATIONAL NURSING & REHAB ADULT, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/01/2013
Last Update Date: 03/03/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

85 NE LOOP 410 SUITE 500
SAN ANTONIO TX
78216-5829
US

IV. Provider business mailing address

85 NE LOOP 410 SUITE 500
SAN ANTONIO TX
78216-5829
US

V. Phone/Fax

Practice location:
  • Phone: 210-822-0475
  • Fax: 210-822-0581
Mailing address:
  • Phone: 210-822-0475
  • Fax: 210-822-0581

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code251J00000X
TaxonomyNursing Care Agency
License Number015644
License Number StateTX
# 2
Primary TaxonomyN
Taxonomy Code253Z00000X
TaxonomyIn Home Supportive Care Agency
License Number015644
License Number StateTX
# 3
Primary TaxonomyY
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License Number015644
License Number StateTX

VIII. Authorized Official

Name: MR. STEVE D WALLACE
Title or Position: CEO
Credential:
Phone: 210-822-0475