| Elder Care Behavioral Health Services | |
|
3220 N Loop 1604 W Shavano Park TX 78231-4401 | |
| (210) 492-4040 | |
| Not Available |
| Full Name | Elder Care Behavioral Health Services |
|---|---|
| Speciality | Psychiatry & Neurology |
| Location | 3220 N Loop 1604 W, Shavano Park, Texas |
| Authorized Official Name and Position | Jennifer Ogburn (CREDENTIALING/CONTRACT MGR) |
| Authorized Official Contact | 2104682015 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Elder Care Behavioral Health Services 5518 Painter Grn San Antonio TX 78240-3144 Ph: (210) 395-4520 | Elder Care Behavioral Health Services 3220 N Loop 1604 W Shavano Park TX 78231-4401 Ph: (210) 492-4040 |
| NPI Number | 1376185298 |
|---|---|
| Provider Enumeration Date | 10/11/2019 |
| Last Update Date | 10/11/2019 |
| Medicare PECOS PAC ID | 9133556160 |
|---|---|
| Medicare Enrollment ID | O20200504001337 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1376185298 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 2084P0805X | Psychiatry & Neurology - Geriatric Psychiatry | (* (Not Available)) | Primary |
| Provider Name | Straight Line Arla |
|---|---|
| Provider Type | Practitioner - Geriatric Psychiatry |
| Provider Identifiers | NPI Number: 1962660068 PECOS PAC ID: 7113177759 Enrollment ID: I20121017000389 |
| Provider Name | Reena Joseph |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1710357538 PECOS PAC ID: 8022312685 Enrollment ID: I20160202002676 |
| Provider Name | Samuel Lucas Lucio |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1033634944 PECOS PAC ID: 5294071775 Enrollment ID: I20190111000812 |
| Provider Name | Randel Bond |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1104427335 PECOS PAC ID: 8820497969 Enrollment ID: I20210524000383 |
| Provider Name | Rebecca Elizabeth Landry |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1316537525 PECOS PAC ID: 0042615882 Enrollment ID: I20210817003379 |
| Provider Name | Raquel M Garcia-priestly |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1750987327 PECOS PAC ID: 7719382142 Enrollment ID: I20210824002101 |
| Provider Name | Teena Thayil |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1548807654 PECOS PAC ID: 5496143398 Enrollment ID: I20211026002187 |
| Provider Name | Valerie Lopez |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1033872452 PECOS PAC ID: 7911397807 Enrollment ID: I20211208002273 |
| Provider Name | George Brosowske |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1083324040 PECOS PAC ID: 7719351352 Enrollment ID: I20230321002164 |
| Provider Name | Kerry Alyson Ramirez |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1568173136 PECOS PAC ID: 3072978949 Enrollment ID: I20230427002044 |
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