MEDICARE: ARMY RETIREMENT RESIDENCE FOUNDATION SAN ANTONIO

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	314000000X	Skilled Nursing Facility	0163	TX

General Provider Information

NPI Number	:	1306801220
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ARMY RETIREMENT RESIDENCE FOUNDATION SAN ANTONIO

Provider Business Mailing Address
First Line	:	7400 CRESTWAY DR
Second Line	:
City	:	SAN ANTONIO
State	:	TX
Zip	:	78239-3098
Country	:	US
Telephone Number	:	210-646-5200
Fax Number	:	210-646-5395

Provider Business Practice Location Address
First Line	:	7400 CRESTWAY DR
Second Line	:
City	:	SAN ANTONIO
State	:	TX
Zip	:	78239-3098
Country	:	US
Telephone Number	:	210-646-5200
Fax Number	:	210-646-5395

Authorized Official
Title or Position	:	CFO
Name	:	MR. BRUCE W CHITTENDEN
Credential	:
Telephone Number	:	210-646-5328

Provider Enumeration Date	:	04/20/2006
Last Update Date	:	04/29/2010

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