Provider Demographics
NPI:1720815053
Name:PAMPERED WELLNESS RECOVERY HOME LLC
Entity type:Organization
Organization Name:PAMPERED WELLNESS RECOVERY HOME LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:TOYA
Authorized Official - Middle Name:
Authorized Official - Last Name:STEWARD
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:708-270-5700
Mailing Address - Street 1:17334 MOSCATO
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78247-4499
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:17334 MOSCATO
Practice Address - Street 2:
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78247-4499
Practice Address - Country:US
Practice Address - Phone:210-777-6099
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-09-19
Last Update Date:2024-09-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes374U00000XNursing Service Related ProvidersHome Health AideGroup - Single Specialty