Provider Demographics
NPI:1386957751
Name:VALLECARE, L.L.C.
Entity type:Organization
Organization Name:VALLECARE, L.L.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:V.P., OPERATIONS
Authorized Official - Prefix:MR
Authorized Official - First Name:EDWARD
Authorized Official - Middle Name:C
Authorized Official - Last Name:HALSTEAD
Authorized Official - Suffix:JR
Authorized Official - Credentials:
Authorized Official - Phone:210-520-1723
Mailing Address - Street 1:PO BOX 681271
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78268-1271
Mailing Address - Country:US
Mailing Address - Phone:210-520-1723
Mailing Address - Fax:210-520-1724
Practice Address - Street 1:9793 CULEBRA RD
Practice Address - Street 2:SUITE 101
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78251-3749
Practice Address - Country:US
Practice Address - Phone:210-520-1723
Practice Address - Fax:210-520-1724
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-07-14
Last Update Date:2010-07-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Multi-Specialty
No224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy AssistantGroup - Multi-Specialty
No225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy AssistantGroup - Multi-Specialty
No225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistGroup - Multi-Specialty
No2355S0801XSpeech, Language and Hearing Service ProvidersSpecialist/TechnologistSpeech-Language AssistantGroup - Multi-Specialty
No235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language PathologistGroup - Multi-Specialty