Provider Demographics
NPI:1306801220
Name:ARMY RETIREMENT RESIDENCE FOUNDATION SAN ANTONIO
Entity type:Organization
Organization Name:ARMY RETIREMENT RESIDENCE FOUNDATION SAN ANTONIO
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CFO
Authorized Official - Prefix:MR
Authorized Official - First Name:BRUCE
Authorized Official - Middle Name:W
Authorized Official - Last Name:CHITTENDEN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:210-646-5328
Mailing Address - Street 1:7400 CRESTWAY DR
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78239-3098
Mailing Address - Country:US
Mailing Address - Phone:210-646-5200
Mailing Address - Fax:210-646-5395
Practice Address - Street 1:7400 CRESTWAY DR
Practice Address - Street 2:
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78239-3098
Practice Address - Country:US
Practice Address - Phone:210-646-5200
Practice Address - Fax:210-646-5395
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-04-20
Last Update Date:2010-04-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX0163314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX675697Medicare Oscar/Certification