Provider Demographics
NPI:1871917971
Name:SAN ANTONIO BEHAVIORAL HEALTHCARE HOSPITAL, LLC
Entity type:Organization
Organization Name:SAN ANTONIO BEHAVIORAL HEALTHCARE HOSPITAL, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE VICE PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:PETER
Authorized Official - Middle Name:BLAIR
Authorized Official - Last Name:STAM
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:951-520-4185
Mailing Address - Street 1:8550 HUEBNER RD
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78240-1803
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:8550 HUEBNER RD
Practice Address - Street 2:
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78240-1803
Practice Address - Country:US
Practice Address - Phone:248-905-5091
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-02-10
Last Update Date:2015-11-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX00000000283Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes283Q00000XHospitalsPsychiatric Hospital
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX3490591-01Medicaid
454132Medicare Oscar/Certification