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General NPI Number Information
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NPI Number | 1063172674
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Entity Type | Organization
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Legal Business Name | RUN REAL CARE FACILITY LLC
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Dates
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Enumeration Date | 12/22/2021
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Last Update Date | 11/07/2023
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Provider Practice Location Address
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Address Line | 6822 LIBERTY STONE
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City | SAN ANTONIO
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State | TX
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Zip | 78244-1377
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Country | US
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Telephone | 207-518-1102
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Fax |
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Provider Business Mailing Address
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Address Line | 6822 LIBERTY STONE
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City | SAN ANTONIO
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State | TX
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Zip | 78244-1377
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Country | US
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Telephone | 207-518-1102
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | DIDIER RUNEZERWA
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Credential |
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Telephone | 207-518-1102
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 3747A0650X
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Taxonomy Name | Attendant Care Provider
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 311ZA0620X
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Taxonomy Name | Adult Care Home Facility
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License Number |
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License Number State |
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