Healthcare Provider Details

I. General information

NPI: 1346462439
Provider Name (Legal Business Name): REGINA WILLIAMS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/02/2007
Last Update Date: 06/18/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3807 WILLOWWOOD BLVD
SAN ANTONIO TX
78219-2537
US

IV. Provider business mailing address

3807 WILLOWWOOD BLVD
SAN ANTONIO TX
78219-2537
US

V. Phone/Fax

Practice location:
  • Phone: 210-227-7054
  • Fax:
Mailing address:
  • Phone: 210-227-7054
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code320700000X
TaxonomyPhysical Disabilities Residential Treatment Facility
License Number689500
License Number StateTX

VIII. Authorized Official

Name: MS. REGINA C. WILLIAMS
Title or Position: OWNER
Credential:
Phone: 210-227-7054