NPIMap

Organization Active NPI

Premieant Inc

Doing business as Forest Glade

  • Intellectual Disabilities Intermediate Care Facility
  • San Antonio, TX
National Provider Identifier
1225792070
Registry record updated Oct 27, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Intellectual Disabilities Intermediate Care FacilityTaxonomy code 315P00000X
Legal business name
PREMIEANT INC
Doing business as
Forest Glade
Forest Glade Home
Practice address
3506 Forest Glade St
San Antonio, TX 78247-3107
Phone
(512) 916-1632
Fax
(512) 916-1639
NPI assigned
Oct 27, 2021
Last updated
Oct 27, 2021By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Oct 27, 2021

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

Authorized official

Name
Jeffrey Engelke
Title
President
Phone
(512) 916-1632

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Intellectual Disabilities Intermediate Care Facility 315P00000X NU Primary

Addresses

Primary practice location

3506 Forest Glade St
San Antonio, TX 78247-3107

Mailing address

1110 W William Cannon Dr BLDG 2
Austin, TX 78745-5468
Phone (512) 916-1632

Other identifiers 11

IdentifierTypeStateIssuer
1144323502MedicaidTX
1235240300MedicaidTX
1871696237MedicaidTX
1124139340MedicaidTX
1326141789MedicaidTX
1467563536MedicaidTX
1235232695MedicaidTX
1396856514MedicaidTX
1871604934MedicaidTX
1407967573MedicaidTX
1962505321MedicaidTX

Other names 2

  • Forest Glade Doing business as
  • Forest Glade Home Doing business as

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Not listed in the public Medicare enrollment file

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1225792070. Details of each certification follow.

  • CCN 45H412 Intermediate care facility for individuals with intellectual disabilities · Active · Name & address match · Details

Intermediate care facility for individuals with intellectual disabilities certification: CCN 45H412

Name & address match This certification has no NPI in the Medicare enrollment files. CMS publishes enrollment files for six facility types only, so it was connected to this NPI by matching the name and address CMS publishes for it.

Legal name
FOREST GLADE HOME
Certification status
Active
Provider type (POS)
Intermediate care facility for individuals with intellectual disabilities
Participating since
May 16, 2022
Last certification
Sep 9, 2025
Beds
6
Ownership / control type
Private (proprietary)
Facility address
3506 Forest Glade Street
San Antonio, TX 78247

National Provider Directory

National Provider Directory
Tax ID family
Premiant Inc28 organizations share this tax ID, including this one

Other organizations with this tax ID 27

Organizations that report the same tax identification number in the National Provider Directory.

View all 27

NPI Registry JSON

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

{
    "created_epoch": "1635292800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1635292800000",
    "number": "1225792070",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1110 W WILLIAM CANNON DR BLDG 2",
            "city": "AUSTIN",
            "state": "TX",
            "postal_code": "787455468",
            "telephone_number": "512-916-1632",
            "fax_number": "512-916-1639"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3506 FOREST GLADE ST",
            "city": "SAN ANTONIO",
            "state": "TX",
            "postal_code": "782473107",
            "telephone_number": "512-916-1632",
            "fax_number": "512-916-1639"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PREMIEANT INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2021-10-27",
        "last_updated": "2021-10-27",
        "certification_date": "2021-10-27",
        "status": "A",
        "authorized_official_last_name": "ENGELKE",
        "authorized_official_first_name": "JEFFREY",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "512-916-1632"
    },
    "taxonomies": [
        {
            "code": "315P00000X",
            "taxonomy_group": "",
            "desc": "Intermediate Care Facility, Intellectual Disabilities",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1144323502",
            "state": "TX"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1235240300",
            "state": "TX"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1871696237",
            "state": "TX"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1124139340",
            "state": "TX"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1326141789",
            "state": "TX"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1467563536",
            "state": "TX"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1235232695",
            "state": "TX"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1396856514",
            "state": "TX"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1871604934",
            "state": "TX"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1407967573",
            "state": "TX"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1962505321",
            "state": "TX"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Forest Glade",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Forest Glade Home",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in San Antonio, TX

Sources for this page

Verify at the official NPI Registry.