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General NPI Number Information
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NPI Number | 1487152401
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Entity Type | Organization
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Legal Business Name | 78 ENTERPRIZE
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Dates
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Enumeration Date | 01/24/2018
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Last Update Date | 01/24/2018
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Provider Practice Location Address
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Address Line | 4837 FREDERICKSBURG RD
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City | SAN ANTONIO
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State | TX
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Zip | 78229-3627
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Country | US
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Telephone | 210-445-8906
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Fax | 210-815-3545
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Provider Business Mailing Address
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Address Line | 4837 FREDERICKSBURG RD
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City | SAN ANTONIO
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State | TX
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Zip | 78229-3627
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Country | US
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Telephone | 210-445-8906
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Fax | 210-815-3545
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Authorized Official
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Title or Position | OWNER/MANAGER
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Name | MARIA HOOPER
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Credential |
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Telephone | 210-445-8906
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 3747A0650X
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Taxonomy Name | Attendant Care Provider
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License Number | 017648
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License Number State | TX
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