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General NPI Number Information
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NPI Number | 1609846997
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Entity Type | Organization
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Legal Business Name | ENHANCED LIVING CENTER LTC
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Dates
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Enumeration Date | 01/26/2006
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 845 PROTON RD
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City | SAN ANTONIO
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State | TX
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Zip | 78258-4203
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Country | US
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Telephone | 210-582-3712
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Fax | 210-582-3812
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Provider Business Mailing Address
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Address Line | 845 PROTON RD
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City | SAN ANTONIO
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State | TX
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Zip | 78258-4203
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Country | US
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Telephone | 210-582-3712
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Fax | 210-582-3812
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Authorized Official
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Title or Position | CFO
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Name | MIKE HAWKER
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Credential |
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Telephone | 210-582-3710
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 313M00000X
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Taxonomy Name | Nursing Facility/Intermediate Care Facility
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License Number | 114887
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License Number State | TX
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