Healthcare Provider Details

I. General information

NPI: 1962069971
Provider Name (Legal Business Name): KOVAL'S ADULT FOSTER HOME
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/24/2019
Last Update Date: 05/24/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

804 MONTICELLO CT
SAN ANTONIO TX
78223-2232
US

IV. Provider business mailing address

802 MONTICELLO CT
SAN ANTONIO TX
78223-2232
US

V. Phone/Fax

Practice location:
  • Phone: 210-534-9451
  • Fax:
Mailing address:
  • Phone: 210-534-9451
  • Fax:

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: MRS. GLADYS M KOVAL
Title or Position: OWNER
Credential:
Phone: 210-534-9451