MEDICARE: HOME AT SILVER QUAIL, INC.

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	315P00000X	Intellectual Disabilities Intermediate Care Facility	115324	TX

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	45H153	OTHER	TX	PROVIDER NUMBER

General Provider Information

NPI Number	:	1831149095
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	HOME AT SILVER QUAIL, INC.

Provider Business Mailing Address
First Line	:	9714 KNOB OAK
Second Line	:
City	:	SAN ANTONIO
State	:	TX
Zip	:	78250-3423
Country	:	US
Telephone Number	:	210-680-6768
Fax Number	:	210-520-0812

Provider Business Practice Location Address
First Line	:	8706 SILVER QUAIL
Second Line	:
City	:	SAN ANTONIO
State	:	TX
Zip	:	78250-6214
Country	:	US
Telephone Number	:	210-680-6768
Fax Number	:	210-520-0812

Authorized Official
Title or Position	:	ADMINISTRATOR
Name	:	MR. MARC F MUCKLEROY
Credential	:
Telephone Number	:	210-680-6768

Provider Enumeration Date	:	05/10/2006
Last Update Date	:	08/22/2020

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