Provider Demographics
NPI:1043537343
Name:RIVER CITY REHABILIATION CENTER, INC.
Entity Type:Organization
Organization Name:RIVER CITY REHABILIATION CENTER, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PROGRAM SPONSOR
Authorized Official - Prefix:MR
Authorized Official - First Name:RAYMOND
Authorized Official - Middle Name:R
Authorized Official - Last Name:CARVAJAL
Authorized Official - Suffix:
Authorized Official - Credentials:RPH
Authorized Official - Phone:210-924-7547
Mailing Address - Street 1:680 STONEWALL ST
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78214-1908
Mailing Address - Country:US
Mailing Address - Phone:210-924-7547
Mailing Address - Fax:210-924-7547
Practice Address - Street 1:680 STONEWALL ST
Practice Address - Street 2:
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78214-1908
Practice Address - Country:US
Practice Address - Phone:210-924-7547
Practice Address - Fax:210-924-7547
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-04-26
Last Update Date:2010-04-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX33324500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes324500000XResidential Treatment FacilitiesSubstance Abuse Rehabilitation Facility