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General NPI Number Information
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NPI Number | 1154329043
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Entity Type | Organization
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Legal Business Name | CENTURY MISSION OAKS GEAC LLC
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Dates
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Enumeration Date | 07/13/2005
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Last Update Date | 06/26/2008
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Provider Practice Location Address
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Address Line | 3030 ROOSEVELT AVE
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City | SAN ANTONIO
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State | TX
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Zip | 78214-2337
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Country | US
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Telephone | 210-924-8151
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Fax | 210-924-2208
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Provider Business Mailing Address
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Address Line | 3030 ROOSEVELT AVE
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City | SAN ANTONIO
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State | TX
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Zip | 78214-2337
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Country | US
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Telephone | 210-924-8151
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Fax | 210-924-2208
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Authorized Official
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Title or Position | FACILITY ADMINISTRATOR
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Name | MRS. MYRNA ROBINSON
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Credential |
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Telephone | 210-924-8151
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 314000000X
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Taxonomy Name | Skilled Nursing Facility
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License Number | 112541
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License Number State | TX
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