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General NPI Number Information
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NPI Number | 1780031237
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Entity Type | Organization
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Legal Business Name | TAJ MANAGEMENT, LLC
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Dates
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Enumeration Date | 05/14/2016
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Last Update Date | 05/14/2016
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Provider Practice Location Address
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Address Line | 10730 POTRANCO RD STE 122-242
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City | SAN ANTONIO
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State | TX
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Zip | 78251-3327
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Country | US
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Telephone | 210-485-6126
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Fax |
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Provider Business Mailing Address
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Address Line | 10730 POTRANCO RD STE 122-242
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City | SAN ANTONIO
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State | TX
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Zip | 78251-3327
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | VARNELL JOHNSON
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Credential |
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Telephone | 210-485-6126
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QR0405X
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Taxonomy Name | Substance Use Disorder Rehabilitation Clinic/Center
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License Number |
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License Number State |
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