Provider Demographics
NPI:1891229670
Name:SOUTH TEXAS VA
Entity Type:Organization
Organization Name:SOUTH TEXAS VA
Other - Org Name:ALMVAH
Other - Org Type:Other Name
Authorized Official - Title/Position:ADDICTION THERAPIST
Authorized Official - Prefix:MR
Authorized Official - First Name:JOSEPH
Authorized Official - Middle Name:ALLEN
Authorized Official - Last Name:MCCANCE
Authorized Official - Suffix:
Authorized Official - Credentials:LCDC
Authorized Official - Phone:210-321-2700
Mailing Address - Street 1:4455 HORIZON HILL BLVD
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78229-2258
Mailing Address - Country:US
Mailing Address - Phone:210-321-2700
Mailing Address - Fax:210-321-2720
Practice Address - Street 1:4455 HORIZON HILL BLVD
Practice Address - Street 2:
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78229-2258
Practice Address - Country:US
Practice Address - Phone:210-321-2700
Practice Address - Fax:210-321-2700
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-04-18
Last Update Date:2017-04-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX12800283X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes283X00000XHospitalsRehabilitation Hospital