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General NPI Number Information
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NPI Number | 1114144854
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Entity Type | Organization
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Legal Business Name | DORA DE SANTIAGO ADULT FOSTER CARE
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Dates
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Enumeration Date | 04/20/2007
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Last Update Date | 09/25/2008
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Provider Practice Location Address
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Address Line | 211 ZACHRY DR
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City | SAN ANTONIO
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State | TX
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Zip | 78228-4157
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Country | US
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Telephone | 210-434-5257
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Fax |
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Provider Business Mailing Address
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Address Line | 211 ZACHRY DR
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City | SAN ANTONIO
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State | TX
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Zip | 78228-4157
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Country | US
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Telephone | 210-434-5257
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Fax | 210-434-5257
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Authorized Official
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Title or Position | OWNER
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Name | DORA DE SANTIAGO
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Credential |
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Telephone | 210-434-5257
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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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 | TX
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