Healthcare Provider Details

I. General information

NPI: 1881954196
Provider Name (Legal Business Name): AIR FORCE VILLAGE II, INCORPORATED
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/21/2012
Last Update Date: 05/21/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5200 JOHN D RYAN BLVD
SAN ANTONIO TX
78245-3514
US

IV. Provider business mailing address

12455 FREEDOM WAY
SAN ANTONIO TX
78245-3526
US

V. Phone/Fax

Practice location:
  • Phone: 210-838-6325
  • Fax:
Mailing address:
  • Phone: 210-838-6325
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code310400000X
TaxonomyAssisted Living Facility
License Number130391
License Number StateTX

VIII. Authorized Official

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