MEDICARE: ENHANCED LIVING CENTER LTC

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	313M00000X	Nursing Facility/Intermediate Care Facility	114887	TX

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1609846997
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ENHANCED LIVING CENTER LTC

Provider Business Mailing Address
First Line	:	845 PROTON RD
Second Line	:
City	:	SAN ANTONIO
State	:	TX
Zip	:	78258-4203
Country	:	US
Telephone Number	:	210-582-3712
Fax Number	:	210-582-3812

Provider Business Practice Location Address
First Line	:	845 PROTON RD
Second Line	:
City	:	SAN ANTONIO
State	:	TX
Zip	:	78258-4203
Country	:	US
Telephone Number	:	210-582-3712
Fax Number	:	210-582-3812

Authorized Official
Title or Position	:	CFO
Name	:	MIKE HAWKER
Credential	:
Telephone Number	:	210-582-3710

Provider Enumeration Date	:	01/26/2006
Last Update Date	:	08/22/2020

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Directions to “ENHANCED LIVING CENTER LTC ” Practice Location

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