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NPI Code Detail

MEDICARE: MISSION ROAD DEVELOPMENTAL CENTER

MEDICARE: MISSION ROAD DEVELOPMENTAL CENTER
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
1251X00000XSupports Brokerage Agency001003128TX

General Provider Information

NPI Number : 1699844969
Entity Type Code : Organization
Provider Name (Legal Business Name) : MISSION ROAD DEVELOPMENTAL CENTER
Provider Business Mailing Address
First Line : 8706 MISSION RD
Second Line :
City : SAN ANTONIO
State : TX
Zip : 78214-3140
Country : US
Telephone Number : 210-924-9265
Fax Number :
Provider Business Practice Location Address
First Line : 8706 MISSION RD
Second Line :
City : SAN ANTONIO
State : TX
Zip : 78214-3140
Country : US
Telephone Number : 210-924-9265
Fax Number :
Authorized Official
Title or Position : EXECUTIVE DIRECTOR
Name : LORA BUTLER
Credential :
Telephone Number : 210-334-2437
Provider Enumeration Date : 11/08/2006
Last Update Date : 06/26/2008

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Directions to “MISSION ROAD DEVELOPMENTAL CENTER ” Practice Location

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These directions are for planning purposes only. You may find that construction projects, traffic, or other events may cause road conditions to differ from the map results.

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