Organization
MALLKU, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
ENRIQUE LIRA (OWNER)
(210) 387-2599
Entity
Organization
Contact information
Practice address
28 MONDAVI, SAN ANTONIO, TX 78258-4670
(210) 387-2599
Mailing address
28 MONDAVI, SAN ANTONIO, TX 78258-4670
(210) 387-2599
Taxonomy
Speciality
Code
Description
License number
State
320600000X
Intellectual and/or Developmental Disabilities Residential Treatment Facility
—
TX
320700000X
Physical Disabilities Residential Treatment Facility
—
TX
320800000X
Mental Illness Community Based Residential Treatment Facility
—
TX
320900000X
Intellectual and/or Developmental Disabilities Community Based Residential Treatment Facility
Primary
—
TX
323P00000X
Psychiatric Residential Treatment Facility
—
TX
324500000X
Substance Abuse Rehabilitation Facility
—
TX
3245S0500X
Children's Substance Abuse Rehabilitation Facility
—
TX
Other
Enumeration date
05/23/2011
Last updated
05/23/2011
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