Healthcare Provider Details

I. General information

NPI: 1710987342
Provider Name (Legal Business Name): SENIOR HEALTH - ALAMO, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/26/2005
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8223 BROADWAY ST
SAN ANTONIO TX
78209-1919
US

IV. Provider business mailing address

8223 BROADWAY ST
SAN ANTONIO TX
78209-1919
US

V. Phone/Fax

Practice location:
  • Phone: 210-828-0606
  • Fax: 210-826-7766
Mailing address:
  • Phone: 210-828-0606
  • Fax: 210-826-7766

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code314000000X
TaxonomySkilled Nursing Facility
License Number108920
License Number StateTX

VIII. Authorized Official

Name: MR. RANDY BARONET
Title or Position: ADMINISTRATOR
Credential:
Phone: 210-828-0606