MEDICARE: THE PATRICIAN MOVEMENT

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	324500000X	Substance Abuse Rehabilitation Facility

General Provider Information

NPI Number	:	1750439113
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	THE PATRICIAN MOVEMENT

Provider Business Mailing Address
First Line	:	222 E MITCHELL ST
Second Line	:
City	:	SAN ANTONIO
State	:	TX
Zip	:	78210-3845
Country	:	US
Telephone Number	:	210-532-3126
Fax Number	:

Provider Business Practice Location Address
First Line	:	222 E MITCHELL ST
Second Line	:
City	:	SAN ANTONIO
State	:	TX
Zip	:	78210-3845
Country	:	US
Telephone Number	:	210-532-3126
Fax Number	:

Authorized Official
Title or Position	:	EXECUTIVE DIRECTOR
Name	:	DR. PATRICK M. CLANCEY
Credential	:
Telephone Number	:	210-532-3126

Provider Enumeration Date	:	01/08/2007
Last Update Date	:	08/22/2020

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Directions to “THE PATRICIAN MOVEMENT ” Practice Location

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