Provider Demographics
NPI:1992057590
Name:SAN ANTONIO REFUGEE YOUTH SPORTS AMERICA
Entity type:Organization
Organization Name:SAN ANTONIO REFUGEE YOUTH SPORTS AMERICA
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIDRECTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:DADIRI
Authorized Official - Middle Name:YUSSUF
Authorized Official - Last Name:JAMA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:210-875-0229
Mailing Address - Street 1:9650 DATAPOINT DR
Mailing Address - Street 2:SUITE 106
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78229-2389
Mailing Address - Country:US
Mailing Address - Phone:210-875-0229
Mailing Address - Fax:210-593-0434
Practice Address - Street 1:9650 DATAPOINT DR
Practice Address - Street 2:SUITE 106
Practice Address - City:SAN ATNONIO
Practice Address - State:TX
Practice Address - Zip Code:78229
Practice Address - Country:US
Practice Address - Phone:210-875-0229
Practice Address - Fax:210-593-0434
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-10-05
Last Update Date:2014-11-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX014893251E00000X, 253Z00000X, 343900000X
310500000X, 314000000X, 343900000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes343900000XTransportation ServicesNon-emergency Medical Transport (VAN)
Yes251E00000XAgenciesHome Health
No253Z00000XAgenciesIn Home Supportive Care
No310500000XNursing & Custodial Care FacilitiesIntermediate Care Facility, Mental Illness
No314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility