MEDICARE: INBETWEEN LIVING REHABILITATION CENTER

Medicare Provider Information

Scope of Practice

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

#	Taxonomy Code	Taxonomy
1	103TM1800X	Intellectual & Developmental Disabilities Psychologist
2	251S00000X	Community/Behavioral Health Agency
3	251V00000X	Voluntary or Charitable Agency
4	103TR0400X	Rehabilitation Psychologist

General Provider Information

NPI Number	:	1265058010
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	INBETWEEN LIVING REHABILITATION CENTER

Provider Business Mailing Address
First Line	:	9511 PERRIN BEITEL RD APT 205
Second Line	:
City	:	SAN ANTONIO
State	:	TX
Zip	:	78217-3538
Country	:	US
Telephone Number	:	210-238-4427
Fax Number	:

Provider Business Practice Location Address
First Line	:	9511 PERRIN BEITEL RD APT 205
Second Line	:
City	:	SAN ANTONIO
State	:	TX
Zip	:	78217-3538
Country	:	US
Telephone Number	:	210-238-4427
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	DYNASTY ROCHELLE HOLLAND
Credential	:
Telephone Number	:	210-269-9715

Provider Enumeration Date	:	06/17/2020
Last Update Date	:	06/17/2020

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