Provider Demographics
NPI:1669508743
Name:WAGGONER & THOMAS ALLCARE, INC.
Entity Type:Organization
Organization Name:WAGGONER & THOMAS ALLCARE, INC.
Other - Org Name:MOTHER-CHILD SOCIAL SERVICES
Other - Org Type:Doing Business As
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:MS
Authorized Official - First Name:MONICA
Authorized Official - Middle Name:E
Authorized Official - Last Name:TREVINO
Authorized Official - Suffix:
Authorized Official - Credentials:LMSW
Authorized Official - Phone:210-745-3940
Mailing Address - Street 1:4100 E PIEDRAS DR
Mailing Address - Street 2:SUITE 205
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78228-1401
Mailing Address - Country:US
Mailing Address - Phone:210-745-3940
Mailing Address - Fax:210-745-3938
Practice Address - Street 1:4100 E PIEDRAS DR
Practice Address - Street 2:SUITE 205
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78228-1401
Practice Address - Country:US
Practice Address - Phone:210-745-3940
Practice Address - Fax:210-745-3938
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-26
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX31249171M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes171M00000XOther Service ProvidersCase Manager/Care CoordinatorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX171M00000XMedicaid