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General NPI Number Information
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NPI Number | 1255418653
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Entity Type | Organization
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Legal Business Name | MISSION ROAD DEVELOPMENTAL CENTER
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Dates
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Enumeration Date | 11/01/2006
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Last Update Date | 09/08/2025
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Provider Practice Location Address
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Address Line | 460 KOPPLOW PL
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City | SAN ANTONIO
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State | TX
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Zip | 78221-2921
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Country | US
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Telephone | 210-921-9396
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Fax |
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Provider Business Mailing Address
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Address Line | 8706 MISSION RD
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City | SAN ANTONIO
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State | TX
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Zip | 78214-3140
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Country | US
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Telephone | 210-924-9265
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Fax |
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Authorized Official
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Title or Position | PRESIDENT, CEO
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Name | LORA S. BUTLER
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Credential |
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Telephone | 210-334-2437
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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 | 110298
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License Number State | TX
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