MEDICARE: MISSION EVENT SENIOR CENTER LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	261QA0600X	Adult Day Care Clinic/Center

General Provider Information

NPI Number	:	1104380245
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MISSION EVENT SENIOR CENTER LLC

Provider Business Mailing Address
First Line	:	7711 BROADWAY ST APT 13C
Second Line	:
City	:	SAN ANTONIO
State	:	TX
Zip	:	78209-3205
Country	:	US
Telephone Number	:	210-860-8855
Fax Number	:

Provider Business Practice Location Address
First Line	:	5614 SOUTH FLORES STREET
Second Line	:
City	:	SAN ANTONIO
State	:	TX
Zip	:	78214
Country	:	US
Telephone Number	:	210-860-8855
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	KAREN CARTTER
Credential	:
Telephone Number	:	210-860-8855

Provider Enumeration Date	:	01/23/2019
Last Update Date	:	01/07/2020

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