NPIMap

Organization Active NPI

Cornell Corrections of Texas

  • Emotionally Disturbed Childrens' Residential Treatment Facility
  • San Antonio, TX
National Provider Identifier
1952434896
Registry record updated Oct 22, 2009
On this page

Key facts

NPPES NPI Registry
Primary specialty
Emotionally Disturbed Childrens' Residential Treatment FacilityTaxonomy code 322D00000X
Legal business name
CORNELL CORRECTIONS OF TEXAS
Practice address
620 E Afton Oaks Blvd
San Antonio, TX 78232-1236
Phone
(210) 568-8600
Fax
(210) 490-9430
NPI assigned
Mar 13, 2007
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Oct 22, 2009

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

Authorized official

Name
Miss Michelle Ann Martenson
Title
Business Manager
Phone
(210) 568-8600

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Emotionally Disturbed Childrens' Residential Treatment Facility 322D00000X Primary

Addresses

Primary practice location

620 E Afton Oaks Blvd
San Antonio, TX 78232-1236

Mailing address

620 E Afton Oaks Blvd
San Antonio, TX 78232-1236
Phone (210) 568-8600

Other identifiers 1

IdentifierTypeStateIssuer
109325402MedicaidTX

National Provider Directory

National Provider Directory
Tax ID family
Texas Adolescent Treatment Center5 organizations share this tax ID, including this one

Other organizations with this tax ID 4

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

Ownership & related parties

Subparts reporting this organization as parent 1

Organizations that report themselves as subparts in NPPES and name this organization, in the same state, as their parent.

NPI Registry JSON

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

{
    "created_epoch": "1173744000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1256169600000",
    "number": "1952434896",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "620 E AFTON OAKS BLVD",
            "city": "SAN ANTONIO",
            "state": "TX",
            "postal_code": "782321236",
            "telephone_number": "210-568-8600",
            "fax_number": "210-490-9430"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "620 E AFTON OAKS BLVD",
            "city": "SAN ANTONIO",
            "state": "TX",
            "postal_code": "782321236",
            "telephone_number": "210-568-8600",
            "fax_number": "210-490-9430"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "CORNELL CORRECTIONS OF TEXAS",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-03-13",
        "last_updated": "2009-10-22",
        "status": "A",
        "authorized_official_last_name": "MARTENSON",
        "authorized_official_first_name": "MICHELLE",
        "authorized_official_middle_name": "ANN",
        "authorized_official_title_or_position": "BUSINESS MANAGER",
        "authorized_official_telephone_number": "210-568-8600",
        "authorized_official_name_prefix": "Miss"
    },
    "taxonomies": [
        {
            "code": "322D00000X",
            "taxonomy_group": "",
            "desc": "Residential Treatment Facility, Emotionally Disturbed Children",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "109325402",
            "state": "TX"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in San Antonio, TX

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 22, 2009; 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.