Organization
TEXAS ADOLESCENT TREATMENT CENTER
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. SERGIO FERNANDEZ (DIRECTOR)
(210) 568-8500
Entity
Organization
Contact information
Practice address
11845 WEST AVE, APARTMENT 1015, SAN ANTONIO, TX 78216-2554
(210) 772-9540
Mailing address
8550 HUEBNER RD, SAN ANTONIO, TX 78240-1803
(210) 568-8550
(210) 568-0624
Taxonomy
Speciality
Code
Description
License number
State
251S00000X
Community/Behavioral Health Agency
Primary
17401
TX
320800000X
Mental Illness Community Based Residential Treatment Facility
17401
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1475733
—
TX
01
—
147573301
CHIP
TX
Enumeration date
04/12/2007
Last updated
06/25/2008
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