Provider Demographics
NPI:1548749666
Name:METHODIST MISSION HOME
Entity Type:Organization
Organization Name:METHODIST MISSION HOME
Other - Org Name:PROVIDENCE PLACE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CHIEF PROGRAM OFFICER
Authorized Official - Prefix:
Authorized Official - First Name:ANGELICA
Authorized Official - Middle Name:NANEZ
Authorized Official - Last Name:CERVANTES
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:210-696-2410
Mailing Address - Street 1:6487 WHITBY RD
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78240-2131
Mailing Address - Country:US
Mailing Address - Phone:210-696-2410
Mailing Address - Fax:210-888-9550
Practice Address - Street 1:6487 WHITBY RD
Practice Address - Street 2:
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78240-2131
Practice Address - Country:US
Practice Address - Phone:210-696-2410
Practice Address - Fax:210-888-9550
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-08-09
Last Update Date:2018-08-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Multi-Specialty