Provider Demographics
NPI:1306134853
Name:SPECIALTY SELECT CARE CENTER OF SAN ANTONIO LLC
Entity type:Organization
Organization Name:SPECIALTY SELECT CARE CENTER OF SAN ANTONIO LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CHIEF FINANCIAL OFFICER
Authorized Official - Prefix:
Authorized Official - First Name:SHAWN
Authorized Official - Middle Name:
Authorized Official - Last Name:CONLEY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:817-303-4089
Mailing Address - Street 1:905 MEDICAL CENTRE DR STE B
Mailing Address - Street 2:
Mailing Address - City:ARLINGTON
Mailing Address - State:TX
Mailing Address - Zip Code:76012-4755
Mailing Address - Country:US
Mailing Address - Phone:817-303-4089
Mailing Address - Fax:817-795-4975
Practice Address - Street 1:6211 SOUTH NEW BRAUNFELS AVENUE
Practice Address - Street 2:
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78223-3175
Practice Address - Country:US
Practice Address - Phone:817-303-4089
Practice Address - Fax:817-795-4975
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-07-19
Last Update Date:2015-11-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX676297OtherMEDICARE