Healthcare Provider Details

I. General information

NPI: 1437317245
Provider Name (Legal Business Name): RIVERCITY REHABILITATION CENTER, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/29/2008
Last Update Date: 08/23/2024
Certification Date: 08/23/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

680 STONEWALL ST
SAN ANTONIO TX
78214-1908
US

IV. Provider business mailing address

680 STONEWALL ST
SAN ANTONIO TX
78214-1908
US

V. Phone/Fax

Practice location:
  • Phone: 210-924-7547
  • Fax: 210-924-0527
Mailing address:
  • Phone: 210-924-7547
  • Fax: 210-924-0527

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM2800X
TaxonomyMethadone Clinic
License Number0000033
License Number StateTX

VIII. Authorized Official

Name: RAYMOND CARVAJAL
Title or Position: PRESIDENT
Credential:
Phone: 210-977-1805