Organization
KICO
Active
Organization
KICO
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MS. MARY EDITH WEDDINGTON (OWNER)
(210) 896-1331
Entity
Organization
Contact information
Practice address
4931 MESA BONITA, SAN ANTONIO, TX 78218-2756
(210) 896-1331
(210) 896-1331
Mailing address
4931 MESA BONITA, SAN ANTONIO, TX 78218-2756
(210) 896-1331
(210) 896-1331
Taxonomy
Speciality
Code
Description
License number
State
320900000X
Intellectual and/or Developmental Disabilities Community Based Residential Treatment Facility
Primary
—
—
Other
Enumeration date
01/13/2010
Last updated
01/13/2010
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