Provider Demographics
NPI:1437428257
Name:MENTIS NEURO SAN ANTONIO, LLC
Entity Type:Organization
Organization Name:MENTIS NEURO SAN ANTONIO, LLC
Other - Org Name:MENTIS NEURO HEALTH
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CHIEF FINANCIAL OFFICER
Authorized Official - Prefix:
Authorized Official - First Name:SERGIO
Authorized Official - Middle Name:P
Authorized Official - Last Name:CRUZ
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:781-708-9444
Mailing Address - Street 1:6565 WEST LOOP SOUTH
Mailing Address - Street 2:STE. 410
Mailing Address - City:BELLAIRE
Mailing Address - State:TX
Mailing Address - Zip Code:77401-3519
Mailing Address - Country:US
Mailing Address - Phone:713-820-4200
Mailing Address - Fax:713-820-4220
Practice Address - Street 1:18931 HARDY OAK BLVD
Practice Address - Street 2:
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78258-4966
Practice Address - Country:US
Practice Address - Phone:210-742-2397
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-12-22
Last Update Date:2019-11-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes320700000XResidential Treatment FacilitiesResidential Treatment Facility, Physical Disabilities