Healthcare Provider Details

I. General information

NPI: 1720895071
Provider Name (Legal Business Name): ELISA M DURDA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/11/2024
Last Update Date: 01/24/2025
Certification Date: 01/16/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

147 CROESUS AVE
SAN ANTONIO TX
78213-4416
US

IV. Provider business mailing address

147 CROESUS AVE
SAN ANTONIO TX
78213-4416
US

V. Phone/Fax

Practice location:
  • Phone: 210-452-8804
  • Fax: 210-979-9251
Mailing address:
  • Phone: 210-452-8804
  • Fax: 210-979-9251

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: ELISA M DURDA
Title or Position: ADULT FOSTERCARE PROVIDER
Credential:
Phone: 210-452-8804