Organization
WORKACCESS
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MS. KATHY OLUBUNMI OGUNDOKUN (CEO)
(254) 458-1084
Entity
Organization
Contact information
Practice address
2740 HUNTERS GREEN ST, SAN ANTONIO, TX 78231-1613
(830) 714-9280
Mailing address
3918 CORTONA WAY, SAN ANTONIO, TX 78260-2579
(830) 714-9280
Taxonomy
Speciality
Code
Description
License number
State
385H00000X
Respite Care
—
TX
385HR2055X
Child Mental Illness Respite Care
—
TX
385HR2060X
Child Intellectual and/or Developmental Disabilities Respite Care
Primary
—
TX
385HR2065X
Child Physical Disabilities Respite Care
—
TX
Other
Enumeration date
09/12/2011
Last updated
09/12/2011
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