MEDICARE: BEXAR COUNTY BOARD OF TRUSTEES FOR MHMR

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
2	251S00000X	Community/Behavioral Health Agency

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	001010447	OTHER	TX	TXHLW CONTRACT NUMBER

General Provider Information

NPI Number	:	1942340526
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	BEXAR COUNTY BOARD OF TRUSTEES FOR MHMR

Provider Business Mailing Address
First Line	:	6800 PARK TEN BLVD STE 200S
Second Line	:
City	:	SAN ANTONIO
State	:	TX
Zip	:	78213-4293
Country	:	US
Telephone Number	:	210-261-1000
Fax Number	:	210-261-1821

Provider Business Practice Location Address
First Line	:	8155 LONE SHADOW TRL
Second Line	:
City	:	CONVERSE
State	:	TX
Zip	:	78109-2436
Country	:	US
Telephone Number	:	210-659-5857
Fax Number	:	210-659-7460

Authorized Official
Title or Position	:	CREDENTIALING SUPERVISOR
Name	:	EUGENE GARCIA
Credential	:
Telephone Number	:	210-261-1072

Provider Enumeration Date	:	02/06/2007
Last Update Date	:	05/26/2023

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