Healthcare Provider Details

I. General information

NPI: 1306134853
Provider Name (Legal Business Name): SPECIALTY SELECT CARE CENTER OF SAN ANTONIO LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/19/2011
Last Update Date: 11/17/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6211 SOUTH NEW BRAUNFELS AVENUE
SAN ANTONIO TX
78223-3175
US

IV. Provider business mailing address

905 MEDICAL CENTRE DR STE B
ARLINGTON TX
76012-4755
US

V. Phone/Fax

Practice location:
  • Phone: 817-303-4089
  • Fax: 817-795-4975
Mailing address:
  • Phone: 817-303-4089
  • Fax: 817-795-4975

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code314000000X
TaxonomySkilled Nursing Facility
License Number
License Number State

VIII. Authorized Official

Name: SHAWN CONLEY
Title or Position: CHIEF FINANCIAL OFFICER
Credential:
Phone: 817-303-4089