Healthcare Provider Details

I. General information

NPI: 1215309661
Provider Name (Legal Business Name): BST HEALTH SERVICES CORP
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/26/2015
Last Update Date: 10/26/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4949 RAVENSWOOD DR
SAN ANTONIO TX
78227-4320
US

IV. Provider business mailing address

12455 FREEDOM WAY
SAN ANTONIO TX
78245-3526
US

V. Phone/Fax

Practice location:
  • Phone: 210-568-5061
  • Fax:
Mailing address:
  • Phone: 210-838-6335
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code310400000X
TaxonomyAssisted Living Facility
License Number141166
License Number StateTX

VIII. Authorized Official

Name: BRIAN ENGLUND
Title or Position: CPA
Credential: CFO
Phone: 210-838-6325