Individual
MS. COSTANCE YVETTE STATEN
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
DIRECTOR
Contact information
Practice address
7000 GULFSHORE, SAN ANTONO, TX 78244
(210) 707-7784
Mailing address
7000 GULF SHORE BLVD, SAN ANTONIO, TX 78244-1535
(210) 707-7784
Taxonomy
Speciality
Code
Description
License number
State
310400000X
Assisted Living Facility
Primary
121763
TX
3104A0625X
Assisted Living Facility (Mental Illness)
121763
TX
3104A0630X
Assisted Living Facility (Behavioral Disturbances)
21763
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
51430089
—
TX
Enumeration date
05/29/2008
Last updated
05/29/2008
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