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General NPI Number Information
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NPI Number | 1356652440
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Entity Type | Organization
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Legal Business Name | ANGEL PLACE ASSISTED LIVING
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Dates
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Enumeration Date | 06/23/2010
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Last Update Date | 06/23/2010
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Provider Practice Location Address
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Address Line | 3911 SHERRILBROOK
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City | SAN ANTONIO
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State | TX
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Zip | 78228-2846
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Country | US
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Telephone | 210-435-8234
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Fax | 210-435-8234
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Provider Business Mailing Address
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Address Line | 3911 SHERRILBROOK
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City | SAN ANTONIO
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State | TX
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Zip | 78228-2846
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Country | US
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Telephone | 210-435-8234
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Fax | 210-435-8234
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Authorized Official
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Title or Position | CEO/ADMINISTRATOR
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Name | MR. LOWELL A LAMASTER
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Credential |
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Telephone | 210-618-6436
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 310400000X
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Taxonomy Name | Assisted Living Facility
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License Number | 126234
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License Number State | TX
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