Provider Demographics
NPI:1821004151
Name:CHRISTUS SANTA ROSA HEALTH CARE CORPORATION
Entity Type:Organization
Organization Name:CHRISTUS SANTA ROSA HEALTH CARE CORPORATION
Other - Org Name:CHILDRENS HOSPITAL OF SAN ANTONIO
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:CRIS
Authorized Official - Middle Name:
Authorized Official - Last Name:DASKEVICH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:210-704-4899
Mailing Address - Street 1:PO BOX 846131
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75284-6131
Mailing Address - Country:US
Mailing Address - Phone:800-756-7999
Mailing Address - Fax:469-282-1791
Practice Address - Street 1:333 N SANTA ROSA ST
Practice Address - Street 2:
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78207-3108
Practice Address - Country:US
Practice Address - Phone:210-704-3907
Practice Address - Fax:210-704-3758
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:CHRISTUS SANTA ROSA HEALTH CARE CORPORATION
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2006-07-31
Last Update Date:2022-08-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
1223S0112X
TX000339261QA1903X, 273Y00000X, 282N00000X, 282NC2000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes282NC2000XHospitalsGeneral Acute Care HospitalChildren
No1223S0112XDental ProvidersDentistOral and Maxillofacial SurgeryGroup - Single Specialty
No261QA1903XAmbulatory Health Care FacilitiesClinic/CenterAmbulatory SurgicalGroup - Single Specialty
No273Y00000XHospital UnitsRehabilitation Unit
No282N00000XHospitalsGeneral Acute Care Hospital
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX909665OtherCONNECTICARE
TX38224OtherHEALTH ALLIANCE PLAN
TX1011RCOtherCOMMUNITY FIRST STAR
TXA7829101OtherJOHN DEERE
TX0007OtherTRICARE FOR LIFE
TXHH0884OtherBLUE CROSS
TX1011OtherCOMMUNITY FIRST
TXH04980OtherOXFORD HEALTH PLAN
TX094356502OtherAMERICAID
TX6542420OtherAETNA