MEDICARE: STEPPING STONES DAY HABLITATION, 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	251C00000X	Developmentally Disabled Services Day Training Agency

General Provider Information

NPI Number	:	1669178711
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	STEPPING STONES DAY HABLITATION, LLC

Provider Business Mailing Address
First Line	:	9714 KNOB OAK
Second Line	:
City	:	SAN ANTONIO
State	:	TX
Zip	:	78250-3423
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	5545 NW LOOP 410 STE 114
Second Line	:
City	:	SAN ANTONIO
State	:	TX
Zip	:	78238-1827
Country	:	US
Telephone Number	:	210-726-4440
Fax Number	:

Authorized Official
Title or Position	:	MEMBER
Name	:	MR. MARC MUCKLEROY
Credential	:
Telephone Number	:	210-386-8277

Provider Enumeration Date	:	01/31/2023
Last Update Date	:	01/31/2023

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