Healthcare Provider Details

I. General information

NPI: 1326224890
Provider Name (Legal Business Name): SCHERRY MOSES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/15/2008
Last Update Date: 06/30/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

552 S WW WHITE RD
SAN ANTONIO TX
78220-1778
US

IV. Provider business mailing address

PO BOX 201602
SAN ANTONIO TX
78220-8602
US

V. Phone/Fax

Practice location:
  • Phone: 210-337-3725
  • Fax:
Mailing address:
  • Phone: 210-337-3725
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code311Z00000X
TaxonomyCustodial Care Facility
License Number122069
License Number StateTX

VIII. Authorized Official

Name: SCHERRY LYNN MOSES
Title or Position: OWNER
Credential:
Phone: 210-337-3725