Provider Demographics
NPI:1376185298
Name:ELDER CARE BEHAVIORAL HEALTH SERVICES
Entity Type:Organization
Organization Name:ELDER CARE BEHAVIORAL HEALTH SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CREDENTIALING/CONTRACT MGR
Authorized Official - Prefix:
Authorized Official - First Name:JENNIFER
Authorized Official - Middle Name:
Authorized Official - Last Name:OGBURN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:210-468-2015
Mailing Address - Street 1:5518 PAINTER GRN
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78240-3144
Mailing Address - Country:US
Mailing Address - Phone:210-395-4520
Mailing Address - Fax:210-395-4521
Practice Address - Street 1:3220 N LOOP 1604 W
Practice Address - Street 2:
Practice Address - City:SHAVANO PARK
Practice Address - State:TX
Practice Address - Zip Code:78231-4401
Practice Address - Country:US
Practice Address - Phone:210-492-4040
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-10-11
Last Update Date:2019-10-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084P0805XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyGeriatric PsychiatryGroup - Single Specialty