Provider Demographics
NPI:1942405154
Name:MELISSA ROXANNE ACOSTA
Entity Type:Organization
Organization Name:MELISSA ROXANNE ACOSTA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MS
Authorized Official - First Name:MELISSA
Authorized Official - Middle Name:ROXANNE
Authorized Official - Last Name:ACOSTA
Authorized Official - Suffix:
Authorized Official - Credentials:MED
Authorized Official - Phone:210-922-7227
Mailing Address - Street 1:5537 S ZARZAMORA ST
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78211-2044
Mailing Address - Country:US
Mailing Address - Phone:210-922-7227
Mailing Address - Fax:210-922-7227
Practice Address - Street 1:5537 S ZARZAMORA ST
Practice Address - Street 2:
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78211-2044
Practice Address - Country:US
Practice Address - Phone:210-922-7227
Practice Address - Fax:210-922-7227
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-06-18
Last Update Date:2022-07-21
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