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General NPI Number Information
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NPI Number | 1326224890
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Entity Type | Organization
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Legal Business Name | SCHERRY MOSES
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Dates
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Enumeration Date | 01/15/2008
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Last Update Date | 06/30/2008
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Provider Practice Location Address
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Address Line | 552 S WW WHITE RD
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City | SAN ANTONIO
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State | TX
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Zip | 78220-1778
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Country | US
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Telephone | 210-337-3725
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 201602
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City | SAN ANTONIO
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State | TX
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Zip | 78220-8602
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Country | US
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Telephone | 210-337-3725
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | SCHERRY LYNN MOSES
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Credential |
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Telephone | 210-337-3725
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 311Z00000X
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Taxonomy Name | Custodial Care Facility
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License Number | 122069
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License Number State | TX
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