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General NPI Number Information
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NPI Number | 1275013328
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Entity Type | Organization
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Legal Business Name | SISTERCARE LLC
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Dates
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Enumeration Date | 08/17/2018
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Last Update Date | 11/05/2024
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Provider Practice Location Address
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Address Line | 6322 SOVEREIGN ST STE 139
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City | SAN ANTONIO
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State | TX
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Zip | 78229-5133
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Country | US
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Telephone | 210-386-2993
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Fax |
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Provider Business Mailing Address
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Address Line | 6322 SOVEREIGN ST STE 139
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City | SAN ANTONIO
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State | TX
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Zip | 78229-5133
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Country | US
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Telephone | 210-386-2993
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | KELLEY LOGANS-ALI
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Credential | LCSW, LCDC
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Telephone | 210-386-2993
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251S00000X
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Taxonomy Name | Community/Behavioral Health Agency
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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 | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | 36044
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License Number State | TX
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Taxonomy #3
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Taxonomy Code | 251B00000X
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Taxonomy Name | Case Management Agency
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License Number |
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License Number State |
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