MEDICARE: ONTO TREATMENT 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
1	261QR0405X	Substance Use Disorder Rehabilitation Clinic/Center

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	J2209	OTHER		TX LICENSE

General Provider Information

NPI Number	:	1841768702
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ONTO TREATMENT CENTER

Provider Business Mailing Address
First Line	:	45 NE LOOP 410 STE 850
Second Line	:
City	:	SAN ANTONIO
State	:	TX
Zip	:	78216-5824
Country	:	US
Telephone Number	:	210-805-9800
Fax Number	:

Provider Business Practice Location Address
First Line	:	23103 IH 10 W STE 105
Second Line	:
City	:	SAN ANTONIO
State	:	TX
Zip	:	78257-1689
Country	:	US
Telephone Number	:	210-614-4805
Fax Number	:	210-614-4009

Authorized Official
Title or Position	:	OWNER
Name	:	ELLEN DUNCAN
Credential	:	MD
Telephone Number	:	210-614-4805

Provider Enumeration Date	:	11/08/2018
Last Update Date	:	11/09/2018

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Directions to “ONTO TREATMENT CENTER ” Practice Location

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