Provider Demographics
NPI:1851747208
Name:ATHENA
Entity Type:Organization
Organization Name:ATHENA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MRS
Authorized Official - First Name:MONICA
Authorized Official - Middle Name:ATHENA
Authorized Official - Last Name:LARIOS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:830-469-5190
Mailing Address - Street 1:137 CASTLEWOOD DR
Mailing Address - Street 2:
Mailing Address - City:SEGUIN
Mailing Address - State:TX
Mailing Address - Zip Code:78155-8102
Mailing Address - Country:US
Mailing Address - Phone:830-469-5190
Mailing Address - Fax:
Practice Address - Street 1:137 CASTLEWOOD DR
Practice Address - Street 2:
Practice Address - City:SEGUIN
Practice Address - State:TX
Practice Address - Zip Code:78155-8102
Practice Address - Country:US
Practice Address - Phone:830-469-5190
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-05-04
Last Update Date:2016-05-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX320900000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes320900000XResidential Treatment FacilitiesCommunity Based Residential Treatment Facility, Intellectual and/or Developmental Disabilities