Organization Name: | MELISSA ROXANNE ACOSTA |
NPI Number: | 1942405154 |
Entity Type Code: | Organizational (2) |
Authorized Official Name: | MELISSA ROXANNE ACOSTA (ADMINISTRATOR) |
Mailing Address: | 5537 S Zarzamora St San Antonio |
State: | TX US |
Postal Code: | 782112044 |
Phone Number: | 2109227227 |
Fax Number: | 2109227227 |
NPI Enumeration Date: | 06/18/2007 |
NPI Last Update Date: | 08/04/2008 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 320900000X |
License Number: | ========= |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | TX |
Taxonomy Type: | Residential Treatment Facilities |
Taxonomy Classification: | Community Based Residential Treatment, Mental Retardation and/or Developmental Disabilities |
Taxonomy Specialization: | |
Taxonomy Definition: | A home-like residential facility providing habilitation, support and monitoring services to individuals diagnosed with mental retardation and/or developmental disabilities. |