Provider Demographics
NPI:1194199786
Name:ST. MICHAEL PROVIDERS LLC
Entity Type:Organization
Organization Name:ST. MICHAEL PROVIDERS LLC
Other - Org Name:PROVIDER SERVICE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MS
Authorized Official - First Name:ESTHER
Authorized Official - Middle Name:JADE
Authorized Official - Last Name:SANMIGUEL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:210-960-2244
Mailing Address - Street 1:104 PARDO CIR
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78228-5025
Mailing Address - Country:US
Mailing Address - Phone:210-960-2244
Mailing Address - Fax:210-960-2240
Practice Address - Street 1:104 PARDO CIR
Practice Address - Street 2:
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78228-5025
Practice Address - Country:US
Practice Address - Phone:210-960-2244
Practice Address - Fax:210-960-2240
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-11-19
Last Update Date:2021-02-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes3747P1801XNursing Service Related ProvidersTechnicianPersonal Care AttendantGroup - Single Specialty
No251C00000XAgenciesDay Training, Developmentally Disabled ServicesGroup - Single Specialty
No385H00000XRespite Care FacilityRespite CareGroup - Single Specialty