Provider Demographics
NPI:1548711310
Name:BLACK NURSES ROCK SAN ANTONIO CHAPTER
Entity type:Organization
Organization Name:BLACK NURSES ROCK SAN ANTONIO CHAPTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO /PRESIDENT
Authorized Official - Prefix:MRS
Authorized Official - First Name:CHARLOTTE
Authorized Official - Middle Name:
Authorized Official - Last Name:DAVIS
Authorized Official - Suffix:
Authorized Official - Credentials:LPN
Authorized Official - Phone:830-480-3616
Mailing Address - Street 1:9014 SUMMIT LK
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78245-1843
Mailing Address - Country:US
Mailing Address - Phone:830-480-3616
Mailing Address - Fax:
Practice Address - Street 1:9014 SUMMIT LK
Practice Address - Street 2:
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78245-1843
Practice Address - Country:US
Practice Address - Phone:830-480-3616
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:BLACK NURSES ROCK
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2016-10-17
Last Update Date:2016-10-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes164W00000XNursing Service ProvidersLicensed Practical NurseGroup - Multi-Specialty
No163W00000XNursing Service ProvidersRegistered NurseGroup - Multi-Specialty