San Antonio III Enterprises, LLC

Primary specialty

Skilled Nursing FacilityTaxonomy code 314000000X

Legal business name

SAN ANTONIO III ENTERPRISES, LLC

Doing business as

Mesa Vista Inn Health Center

Practice address

5756 N Knoll
San Antonio, TX 78240-2238

Phone

(210) 321-5200

Fax

(210) 321-5299

NPI assigned

Mar 12, 2019

Last updated

Mar 12, 2019By the provider in NPPES

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Gary Blake

Title

Managing Member

Phone

(817) 348-8959

Specialties & licenses 1

Addresses

Other names 1

• Mesa Vista Inn Health Center Doing business as

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1552348800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1552348800000",
    "number": "1033677877",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4150 INTERNATIONAL PLZ STE 600",
            "city": "FORT WORTH",
            "state": "TX",
            "postal_code": "761094831"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "5756 N KNOLL",
            "city": "SAN ANTONIO",
            "state": "TX",
            "postal_code": "782402238",
            "telephone_number": "210-321-5200",
            "fax_number": "210-321-5299"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SAN ANTONIO III ENTERPRISES, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2019-03-12",
        "last_updated": "2019-03-12",
        "status": "A",
        "authorized_official_last_name": "BLAKE",
        "authorized_official_first_name": "GARY",
        "authorized_official_title_or_position": "MANAGING MEMBER",
        "authorized_official_telephone_number": "817-348-8959"
    },
    "taxonomies": [
        {
            "code": "314000000X",
            "taxonomy_group": "",
            "desc": "Skilled Nursing Facility",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Mesa Vista Inn Health Center",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

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• Skilled Nursing Facility in San Antonio, TX
• Providers in San Antonio, TX by specialty
• Skilled Nursing Facility in Texas

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 12, 2019; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.