Healthcare Provider Details

I. General information

NPI: 1114144854
Provider Name (Legal Business Name): DORA DE SANTIAGO ADULT FOSTER CARE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/20/2007
Last Update Date: 09/25/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

211 ZACHRY DR
SAN ANTONIO TX
78228-4157
US

IV. Provider business mailing address

211 ZACHRY DR
SAN ANTONIO TX
78228-4157
US

V. Phone/Fax

Practice location:
  • Phone: 210-434-5257
  • Fax:
Mailing address:
  • Phone: 210-434-5257
  • Fax: 210-434-5257

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code311ZA0620X
TaxonomyAdult Care Home Facility
License Number
License Number StateTX

VIII. Authorized Official

Name: DORA DE SANTIAGO
Title or Position: OWNER
Credential:
Phone: 210-434-5257