Provider Demographics
NPI:1578245205
Name:SUMMIT BHC SAN ANTONIO LLC
Entity Type:Organization
Organization Name:SUMMIT BHC SAN ANTONIO LLC
Other - Org Name:STONE RIVER RECOVERY CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CLO
Authorized Official - Prefix:
Authorized Official - First Name:PAUL
Authorized Official - Middle Name:D
Authorized Official - Last Name:GILBERT
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:615-716-4924
Mailing Address - Street 1:389 NICHOL MILL LN STE 100&160
Mailing Address - Street 2:
Mailing Address - City:FRANKLIN
Mailing Address - State:TN
Mailing Address - Zip Code:37067-4882
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:12508 JONES MALTSBERGER RD
Practice Address - Street 2:
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78247-4214
Practice Address - Country:US
Practice Address - Phone:877-463-3553
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-08-02
Last Update Date:2023-12-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR0405XAmbulatory Health Care FacilitiesClinic/CenterRehabilitation, Substance Use Disorder
Yes324500000XResidential Treatment FacilitiesSubstance Abuse Rehabilitation Facility