MEDICARE: SCHERRY MOSES

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	311Z00000X	Custodial Care Facility	122069	TX

General Provider Information

NPI Number	:	1326224890
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SCHERRY MOSES

Provider Business Mailing Address
First Line	:	PO BOX 201602
Second Line	:
City	:	SAN ANTONIO
State	:	TX
Zip	:	78220-8602
Country	:	US
Telephone Number	:	210-337-3725
Fax Number	:

Provider Business Practice Location Address
First Line	:	552 S WW WHITE RD
Second Line	:
City	:	SAN ANTONIO
State	:	TX
Zip	:	78220-1778
Country	:	US
Telephone Number	:	210-337-3725
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	SCHERRY LYNN MOSES
Credential	:
Telephone Number	:	210-337-3725

Provider Enumeration Date	:	01/15/2008
Last Update Date	:	06/30/2008

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