Provider Demographics
NPI:1013348788
Name:CARPENTER HEALTH MANAGEMENT, LLC
Entity Type:Organization
Organization Name:CARPENTER HEALTH MANAGEMENT, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:INSURANCE
Authorized Official - Prefix:MRS
Authorized Official - First Name:ENID
Authorized Official - Middle Name:
Authorized Official - Last Name:CAZARES
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:830-816-4357
Mailing Address - Street 1:1510 SOUTH MAIN ST.
Mailing Address - Street 2:
Mailing Address - City:BOERNE
Mailing Address - State:TX
Mailing Address - Zip Code:78006-2945
Mailing Address - Country:US
Mailing Address - Phone:830-816-4357
Mailing Address - Fax:830-331-8718
Practice Address - Street 1:1510 SOUTH MAIN ST.
Practice Address - Street 2:
Practice Address - City:BOERNE
Practice Address - State:TX
Practice Address - Zip Code:78006-2945
Practice Address - Country:US
Practice Address - Phone:830-816-4357
Practice Address - Fax:830-331-8718
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-12-06
Last Update Date:2014-02-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1127710225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Multi-Specialty