Provider Demographics
NPI: | 1629406764 |
---|---|
Name: | ALAMO COMMUNITY SERVICES |
Entity Type: | Organization |
Organization Name: | ALAMO COMMUNITY SERVICES |
Other - Org Name: | |
Other - Org Type: | |
Authorized Official - Title/Position: | MANAGER |
Authorized Official - Prefix: | |
Authorized Official - First Name: | JOAQUIN |
Authorized Official - Middle Name: | |
Authorized Official - Last Name: | CABALLERO |
Authorized Official - Suffix: | |
Authorized Official - Credentials: | |
Authorized Official - Phone: | 210-896-0531 |
Mailing Address - Street 1: | 5702 SAGE HOLW |
Mailing Address - Street 2: | |
Mailing Address - City: | SAN ANTONIO |
Mailing Address - State: | TX |
Mailing Address - Zip Code: | 78249-3150 |
Mailing Address - Country: | US |
Mailing Address - Phone: | 210-896-0531 |
Mailing Address - Fax: | |
Practice Address - Street 1: | 5702 SAGE HOLW |
Practice Address - Street 2: | |
Practice Address - City: | SAN ANTONIO |
Practice Address - State: | TX |
Practice Address - Zip Code: | 78249-3150 |
Practice Address - Country: | US |
Practice Address - Phone: | 210-896-0531 |
Practice Address - Fax: | |
EIN: | <UNAVAIL> |
Is Organization Subpart?: | No |
Parent Organization LBN: | |
Parent Organization TIN: | |
Enumeration Date: | 2013-10-29 |
Last Update Date: | 2015-07-27 |
Deactivation Date: | |
Deactivation Code: | |
Reactivation Date: |
Provider Licenses
State | License ID | Taxonomies |
---|---|---|
TX | 320600000X |
Provider Taxonomies
Primary? | Code | Type | Classification | Specialization |
---|---|---|---|---|
Yes | 320600000X | Residential Treatment Facilities | Residential Treatment Facility, Intellectual and/or Developmental Disabilities |