MEDICARE: WE CARE RESIDENTIAL SERVICE

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	320900000X	Intellectual and/or Developmental Disabilities Community Based Residential Treatment Facility

General Provider Information

NPI Number	:	1194985051
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	WE CARE RESIDENTIAL SERVICE

Provider Business Mailing Address
First Line	:	259 CHARCLIFF DR
Second Line	:
City	:	SAN ANTONIO
State	:	TX
Zip	:	78220-1637
Country	:	US
Telephone Number	:	210-781-3215
Fax Number	:	210-281-5791

Provider Business Practice Location Address
First Line	:	259 CHARCLIFF DR
Second Line	:
City	:	SAN ANTONIO
State	:	TX
Zip	:	78220-1637
Country	:	US
Telephone Number	:	210-781-3215
Fax Number	:	210-281-5791

Authorized Official
Title or Position	:	OWNER
Name	:	MS. CARMELITA NAKEYA ROSE
Credential	:
Telephone Number	:	210-781-3215

Provider Enumeration Date	:	06/13/2008
Last Update Date	:	06/13/2008

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Directions to “WE CARE RESIDENTIAL SERVICE ” Practice Location

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