MEDICARE: TEXAS ADOLESCENT TREATMENT CENTER

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	320800000X	Mental Illness Community Based Residential Treatment Facility	17401	TX
2	251S00000X	Community/Behavioral Health Agency	17401	TX

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	147573301	OTHER	TX	CHIP
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1356565360
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	TEXAS ADOLESCENT TREATMENT CENTER

Provider Business Mailing Address
First Line	:	8550 HUEBNER RD
Second Line	:
City	:	SAN ANTONIO
State	:	TX
Zip	:	78240-1803
Country	:	US
Telephone Number	:	210-568-8550
Fax Number	:	210-568-0624

Provider Business Practice Location Address
First Line	:	11845 WEST AVE
Second Line	:	APARTMENT 1015
City	:	SAN ANTONIO
State	:	TX
Zip	:	78216-2554
Country	:	US
Telephone Number	:	210-772-9540
Fax Number	:

Authorized Official
Title or Position	:	DIRECTOR
Name	:	MR. SERGIO FERNANDEZ
Credential	:
Telephone Number	:	210-568-8500

Provider Enumeration Date	:	04/12/2007
Last Update Date	:	06/25/2008

Similar Medicare Providers

1588876395 — MRS. PATRICIA KRON BEYER MFT
Practice Location Address:

2901 MOORPARK AVE
SAN JOSE, CA
95128-2554

Practice Phone: 408-243-3536
Practice Fax:

1962738369 — AMY SWENSON
Practice Location Address:

2901 MOORPARK AVE , STE 270
SAN JOSE, CA
95128-2554

Practice Phone: 408-380-1208
Practice Fax: 408-380-1209

1285942946 — EUN AH KIM MA, MFT
Practice Location Address:

2901 MOORPARK AVE , SUITE 270
SAN JOSE, CA
95128-2554

Practice Phone: 408-380-3008
Practice Fax:

1538456173 — DR. LAUREN PALMER BAUMGARTNER DMD, DENTAL CORP.
Practice Location Address:

160 SIR FRANCIS DRAKE BLVD
SAN ANSELMO, CA
94960-2554

Practice Phone: 415-456-9242
Practice Fax:

1801293998 — SABA HASAN
Practice Location Address:

2554 OHLONE DR
SAN JOSE, CA
95132-2630

Practice Phone: 408-251-5595
Practice Fax:

1295233252 — FAYAMAN INC.
Practice Location Address:

16959 BERNARDO CENTER DR STE 105
SAN DIEGO, CA
92128-2554

Practice Phone: 858-247-1005
Practice Fax: 858-724-0290

Directions to “TEXAS ADOLESCENT TREATMENT CENTER ” Practice Location

Language	Start Address	Practice Location

These directions are for planning purposes only. You may find that construction projects, traffic, or other events may cause road conditions to differ from the map results.

Copyright © 2007-2026 (Powered by Swiss Vault Engine), all rights reserved. HIPAA liability, trademark, document use and software licensing rules apply. All registered trademarks, used in the content, are the property of their owners. Your interactions with this site are in accordance with our Terms of Use and Privacy Policy.