Provider Demographics
NPI: | 1427126937 |
---|---|
Name: | PRABETG INC. |
Entity type: | Organization |
Organization Name: | PRABETG INC. |
Other - Org Name: | <UNAVAIL> |
Other - Org Type: | |
Authorized Official - Title/Position: | CHIEF FINANCIAL OFFICE |
Authorized Official - Prefix: | MR |
Authorized Official - First Name: | BRIAN |
Authorized Official - Middle Name: | A |
Authorized Official - Last Name: | THOMAS |
Authorized Official - Suffix: | |
Authorized Official - Credentials: | |
Authorized Official - Phone: | 210-464-6089 |
Mailing Address - Street 1: | 6292 MONTGOMERY DR |
Mailing Address - Street 2: | |
Mailing Address - City: | SAN ANTONIO |
Mailing Address - State: | TX |
Mailing Address - Zip Code: | 78239-3237 |
Mailing Address - Country: | US |
Mailing Address - Phone: | 210-590-6840 |
Mailing Address - Fax: | 210-590-7559 |
Practice Address - Street 1: | 6292 MONTGOMERY |
Practice Address - Street 2: | SUITE 101 |
Practice Address - City: | SAN ANTONIO |
Practice Address - State: | TX |
Practice Address - Zip Code: | 78239-3237 |
Practice Address - Country: | US |
Practice Address - Phone: | 210-590-6840 |
Practice Address - Fax: | 210-590-7559 |
EIN: | <UNAVAIL> |
Is Organization Subpart?: | No |
Parent Organization LBN: | |
Parent Organization TIN: | |
Enumeration Date: | 2006-12-01 |
Last Update Date: | 2008-09-25 |
Deactivation Date: | |
Deactivation Code: | |
Reactivation Date: |
Provider Licenses
State | License ID | Taxonomies |
---|---|---|
TX | 121771 | 261QA0600X |
Provider Taxonomies
Primary? | Code | Type | Classification | Specialization |
---|---|---|---|---|
Yes | 261QA0600X | Ambulatory Health Care Facilities | Clinic/Center | Adult Day Care |