Provider Demographics
NPI:1568559755
Name:THI OF TEXAS AT SAN ANTONIO II, LLC
Entity Type:Organization
Organization Name:THI OF TEXAS AT SAN ANTONIO II, LLC
Other - Org Name:TEXAS SPECIALTY HOSPITAL AT SAN ANTONIO
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:LARRY
Authorized Official - Middle Name:
Authorized Official - Last Name:WITTIGAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:210-308-0261
Mailing Address - Street 1:930 RIDGEBROOK RD
Mailing Address - Street 2:
Mailing Address - City:SPARKS
Mailing Address - State:MD
Mailing Address - Zip Code:21152-9390
Mailing Address - Country:US
Mailing Address - Phone:410-773-1000
Mailing Address - Fax:
Practice Address - Street 1:7310 OAK MANOR DR
Practice Address - Street 2:
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78229-4509
Practice Address - Country:US
Practice Address - Phone:210-308-0261
Practice Address - Fax:210-308-5972
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-07
Last Update Date:2008-03-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes282E00000XHospitalsLong Term Care Hospital
Provider Identifiers
StateIdentifier IDID TypeIssuer
452040Medicare Oscar/Certification