Provider Demographics
NPI:1033363056
Name:SAN ANTONIO INDEPENDENT LIVING SERVICES
Entity Type:Organization
Organization Name:SAN ANTONIO INDEPENDENT LIVING SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:KITTY
Authorized Official - Middle Name:L
Authorized Official - Last Name:BRIETZKE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:210-281-1878
Mailing Address - Street 1:1028 S ALAMO ST
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78210-1170
Mailing Address - Country:US
Mailing Address - Phone:210-281-1878
Mailing Address - Fax:210-281-1759
Practice Address - Street 1:1028 S ALAMO ST
Practice Address - Street 2:
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78210-1170
Practice Address - Country:US
Practice Address - Phone:210-281-1878
Practice Address - Fax:210-281-1759
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-11-05
Last Update Date:2008-11-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251B00000XAgenciesCase Management