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General NPI Number Information
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NPI Number | 1134760002
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Entity Type | Organization
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Legal Business Name | PREMIEANT INC
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Dates
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Enumeration Date | 10/02/2019
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Last Update Date | 12/23/2019
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Provider Practice Location Address
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Address Line | 6402 REGENCY CV
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City | SAN ANTONIO
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State | TX
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Zip | 78249-4844
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Country | US
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Telephone | 512-916-1632
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Fax | 512-916-1639
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Provider Business Mailing Address
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Address Line | 1110 W WILLIAM CANNON DR BLDG 2
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City | AUSTIN
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State | TX
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Zip | 78745-5468
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Country | US
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Telephone | 512-916-1632
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Fax | 512-916-1639
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Authorized Official
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Title or Position | PRESIDENT
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Name | JEFFREY ENGELKE
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Credential |
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Telephone | 512-916-1632
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 315P00000X
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Taxonomy Name | Intellectual Disabilities Intermediate Care Facility
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License Number |
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License Number State |
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