Organization
PREMIEANT INC
Active
Other names
Watering Trail Home
Organization subpart
No
Provider details
NPI number
Authorized official
JEFFREY ENGELKE (PRESIDENT)
(512) 916-1632
Entity
Organization
Contact information
Practice address
4926 WATERING TRAIL DR, SAN ANTONIO, TX 78247-5910
(512) 916-1632
(512) 916-1632
Mailing address
1110 W WILLIAM CANNON DR BLDG 2, AUSTIN, TX 78745-5468
(512) 916-1632
(512) 916-1639
Taxonomy
Speciality
Code
Description
License number
State
315P00000X
Intellectual Disabilities Intermediate Care Facility
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1124139340
—
TX
05
—
1144323502
—
TX
05
—
1235232695
—
TX
05
—
1235240300
—
TX
05
—
1326141789
—
TX
05
—
1396856514
—
TX
05
—
1407967573
—
TX
05
—
1467563536
—
TX
05
—
1871604943
—
TX
05
—
1871696237
—
TX
05
—
1962505321
—
TX
Enumeration date
11/22/2021
Last updated
11/22/2021
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