1043280951 NPI number — TEXAS LAUREL RIDGE HOSPITAL LP

Table of content: (NPI 1043280951)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1043280951 NPI number — TEXAS LAUREL RIDGE HOSPITAL LP

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
TEXAS LAUREL RIDGE HOSPITAL LP
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
LAUREL RIDGE TREATMENT CENTER
Provider Other Organization Name Type Code:
3
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1043280951
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
10/28/2015
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
17720 CORPORATE WOODS DR
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
SAN ANTONIO
Provider Business Mailing Address State Name:
TX
Provider Business Mailing Address Postal Code:
78259-3500
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
210-491-9400
Provider Business Mailing Address Fax Number:
210-491-3517

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
17720 CORPORATE WOODS DR
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
SAN ANTONIO
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
78259-3500
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
210-491-9400
Provider Business Practice Location Address Fax Number:
210-491-3517
Provider Enumeration Date:
01/24/2006

Additional Information

Authorized Official

Authorized Official Last Name:
FILTON
Authorized Official First Name:
STEVE
Authorized Official Middle Name:
Authorized Official Title or Position:
SRVP CFO
Authorized Official Telephone Number:
610-768-3300

Provider Taxonomy Codes

  • Taxonomy code: 283Q00000X , with the licence number:  000723 , registered in the state of TX ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 323P00000X , with the licence number: 827024 , registered in the state of TX ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 149461125 , issued by the state of ( AK ) . This identifiers is of the category "MEDICAID".
  • Identifier: 06704836 , issued by the state of ( MS ) . This identifiers is of the category "MEDICAID".
  • Identifier: HH6534 . This is a "BC PARTIAL PIN" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".
  • Identifier: 2000114300A , issued by the state of ( OK ) . This identifiers is of the category "MEDICAID".
  • Identifier: 0413423 , issued by the state of ( MO ) . This identifiers is of the category "MEDICAID".
  • Identifier: 1707414 , issued by the state of ( LA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 6388590 , issued by the state of ( NV ) . This identifiers is of the category "MEDICAID".
  • Identifier: HH3825 . This is a "BC CD PIN" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".
  • Identifier: 783771 , issued by the state of ( AZ ) . This identifiers is of the category "MEDICAID".
  • Identifier: HH0825 . This is a "BC ACUTE PIN" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".
  • Identifier: 119465 . This is a "CBH PIN" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: 51754339 , issued by the state of ( NM ) . This identifiers is of the category "MEDICAID".
  • Identifier: 0012278 , issued by the state of ( IA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 21240902 , issued by the state of ( TX ) . This identifiers is of the category "MEDICAID".
  • Identifier: HS795PI , issued by the state of ( AK ) . This identifiers is of the category "MEDICAID".
  • Identifier: 001951370001 , issued by the state of ( PA ) . This identifiers is of the category "MEDICAID".
  • Identifier: HH6623 . This is a "BC RTC PIN" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".




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