Organization
CORNELL CORRECTIONS OF TEXAS
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MISS MICHELLE ANN MARTENSON (BUSINESS MANAGER)
(210) 568-8600
Entity
Organization
Contact information
Practice address
620 E AFTON OAKS BLVD, SAN ANTONIO, TX 78232-1236
(210) 568-8600
(210) 490-9430
Mailing address
620 E AFTON OAKS BLVD, SAN ANTONIO, TX 78232-1236
(210) 568-8600
(210) 490-9430
Taxonomy
Speciality
Code
Description
License number
State
322D00000X
Emotionally Disturbed Childrens' Residential Treatment Facility
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
109325402
—
TX
Enumeration date
03/13/2007
Last updated
10/22/2009
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