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Organization
SOLE PROPRIETER
Active
Organization
SOLE PROPRIETER
Active
Organization subpart
No
Provider details
NPI number
Authorized official
STEPHANIE RAE REDDING (COTA)
(210) 748-2945
Entity
Organization
Contact information
Practice address
526 PORTRUSH LN, CIBOLO, TX 78108-4340
(210) 748-2945
Mailing address
526 PORTRUSH LN, CIBOLO, TX 78108
Taxonomy
Speciality
Code
Description
License number
State
313M00000X
Nursing Facility/Intermediate Care Facility
3040
AL
314000000X
Skilled Nursing Facility
Primary
10990
FL
Other
Enumeration date
12/28/2010
Last updated
12/28/2010
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