Organization
OPTIMUM RESIDENTIAL SERVICES LTD
Active
Other names
Whistletop
Organization subpart
No
Provider details
NPI number
Authorized official
MR. MIKE HAWKER (CFO)
(210) 340-7155
Entity
Organization
Contact information
Practice address
2579 WESTERN TRAILS BLVD, AUSTIN, TX 78745-1578
(512) 892-2191
(512) 892-2524
Mailing address
845 PROTON RD, SAN ANTONIO, TX 78258-4203
(210) 340-7155
Taxonomy
Speciality
Code
Description
License number
State
310500000X
Mental Illness Intermediate Care Facility
Primary
007274
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
01004809
—
TX
Enumeration date
04/25/2006
Last updated
08/22/2020
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