Healthcare Provider Details

I. General information

NPI: 1598187718
Provider Name (Legal Business Name): LA GLORIA HEALTH SERVICES, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/07/2014
Last Update Date: 01/07/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1003 FAIR AVE SUITE B
SAN ANTONIO TX
78223-1327
US

IV. Provider business mailing address

1003 FAIR AVE SUITE B
SAN ANTONIO TX
78223-1327
US

V. Phone/Fax

Practice location:
  • Phone: 210-323-1365
  • Fax:
Mailing address:
  • Phone: 210-323-1365
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code311ZA0620X
TaxonomyAdult Care Home Facility
License Number015879
License Number StateTX

VIII. Authorized Official

Name: MS. BARBARA SALINAS
Title or Position: ADMINISTRATOR
Credential:
Phone: 210-323-1365