Provider Demographics
NPI:1124073150
Name:SOLARA BEHAVIORAL HEALTH SAN ANTONIO, LLP
Entity type:Organization
Organization Name:SOLARA BEHAVIORAL HEALTH SAN ANTONIO, LLP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:MR
Authorized Official - First Name:NATHAN
Authorized Official - Middle Name:DANIEL
Authorized Official - Last Name:INGRAM
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:281-914-1012
Mailing Address - Street 1:1975 BABCOCK RD
Mailing Address - Street 2:SUITE 140
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78229-4585
Mailing Address - Country:US
Mailing Address - Phone:281-914-1012
Mailing Address - Fax:682-831-9625
Practice Address - Street 1:1975 BABCOCK RD
Practice Address - Street 2:SUITE 140
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78229-4585
Practice Address - Country:US
Practice Address - Phone:281-914-1012
Practice Address - Fax:682-831-9625
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-25
Last Update Date:2012-09-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QC1500XAmbulatory Health Care FacilitiesClinic/CenterCommunity Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX182967301Medicaid
TX182967301Medicaid
TX454912Medicare Oscar/Certification