Provider Demographics
NPI:1194240275
Name:THE SAN ANTONIO CLUBHOUSE, INC.
Entity type:Organization
Organization Name:THE SAN ANTONIO CLUBHOUSE, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CFO
Authorized Official - Prefix:
Authorized Official - First Name:MINOT
Authorized Official - Middle Name:
Authorized Official - Last Name:PRATT
Authorized Official - Suffix:IV
Authorized Official - Credentials:
Authorized Official - Phone:210-798-1619
Mailing Address - Street 1:6851 CITIZENS PKWY STE 100
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78229-3602
Mailing Address - Country:US
Mailing Address - Phone:210-798-1619
Mailing Address - Fax:
Practice Address - Street 1:6851 CITIZENS PKWY STE 100
Practice Address - Street 2:
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78229-3602
Practice Address - Country:US
Practice Address - Phone:210-798-1619
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-08-09
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health
No261QM0850XAmbulatory Health Care FacilitiesClinic/CenterAdult Mental Health