1114473329 NPI number — EMERUS BHS SA THOUSAND OAKS LLC

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1114473329 NPI number — EMERUS BHS SA THOUSAND OAKS LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
EMERUS BHS SA THOUSAND OAKS LLC
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:
Provider Other Organization Name Type Code:
6
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:
1114473329
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
02/21/2025
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
8686 NEW TRAILS DR
Provider Second Line Business Mailing Address:
SUITE 100
Provider Business Mailing Address City Name:
THE WOODLANDS
Provider Business Mailing Address State Name:
TX
Provider Business Mailing Address Postal Code:
77381-1176
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
713-637-1146
Provider Business Mailing Address Fax Number:
281-298-5311

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
4103 N LOOP 1604 W
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:
78249
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
210-572-8415
Provider Business Practice Location Address Fax Number:
713-637-1305
Provider Enumeration Date:
08/28/2016

Additional Information

Authorized Official

Authorized Official Last Name:
SCHMERBECK
Authorized Official First Name:
VICTOR
Authorized Official Middle Name:
Authorized Official Title or Position:
CEO
Authorized Official Telephone Number:
713-929-2076

Provider Taxonomy Codes

  • Taxonomy code: 261QA1903X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 282N00000X , with the licence number: 100116 , registered in the state of TX ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 309798201 , issued by the state of ( TX ) . This identifiers is of the category "MEDICAID".




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