MEDICARE: EMBASSY OF HOPE SA, INC.

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	101YP2500X	Professional Counselor	18633

General Provider Information

NPI Number	:	1497186399
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	EMBASSY OF HOPE SA, INC.

Provider Business Mailing Address
First Line	:	11230 WEST AVE
Second Line	:	SUITE #1103
City	:	SAN ANTONIO
State	:	TX
Zip	:	78213-1350
Country	:	US
Telephone Number	:	210-305-5155
Fax Number	:	210-305-5156

Provider Business Practice Location Address
First Line	:	11230 WEST AVE
Second Line	:	SUITE #1103
City	:	SAN ANTONIO
State	:	TX
Zip	:	78213-1350
Country	:	US
Telephone Number	:	210-305-5155
Fax Number	:	210-305-5156

Authorized Official
Title or Position	:	EXECUTIVE DIRECTOR
Name	:	ELIZABETH CROOKS
Credential	:
Telephone Number	:	210-305-5155

Provider Enumeration Date	:	12/03/2013
Last Update Date	:	08/26/2015

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