MEDICARE: PRESIDIO AL OPCO, LLC

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	310400000X	Assisted Living Facility

General Provider Information

NPI Number	:	1578441598
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	PRESIDIO AL OPCO, LLC

Provider Business Mailing Address
First Line	:	5438 PRESIDIO PKWY
Second Line	:
City	:	SAN ANTONIO
State	:	TX
Zip	:	78249-3495
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	5438 PRESIDIO PKWY
Second Line	:
City	:	SAN ANTONIO
State	:	TX
Zip	:	78249-3495
Country	:	US
Telephone Number	:	210-839-2199
Fax Number	:

Authorized Official
Title or Position	:	AUTHORIZED SIGNATORY
Name	:	FRANK SMALL
Credential	:
Telephone Number	:	917-825-8194

Provider Enumeration Date	:	08/26/2025
Last Update Date	:	08/26/2025

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Directions to “PRESIDIO AL OPCO, LLC ” Practice Location

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