MEDICARE: ESTERS KINGDOM

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	261QA0600X	Adult Day Care Clinic/Center

General Provider Information

NPI Number	:	1558612549
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ESTERS KINGDOM

Provider Business Mailing Address
First Line	:	22 MOONWALK CRST
Second Line	:
City	:	SAN ANTONIO
State	:	TX
Zip	:	78254-2512
Country	:	US
Telephone Number	:	210-757-3398
Fax Number	:

Provider Business Practice Location Address
First Line	:	22 MOONWALK CRST
Second Line	:
City	:	SAN ANTONIO
State	:	TX
Zip	:	78254-2512
Country	:	US
Telephone Number	:	210-757-3398
Fax Number	:

Authorized Official
Title or Position	:	ADMINISTRATOR
Name	:	MRS. DONDALYN ELIZABETH MILES
Credential	:
Telephone Number	:	210-757-3398

Provider Enumeration Date	:	10/01/2012
Last Update Date	:	10/01/2012

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Directions to “ESTERS KINGDOM ” Practice Location

Language	Start Address	Practice Location

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