1205382413 NPI number — EMERUS BHS SA THOUSAND OAKS, LLC

Table of content: (NPI 1205382413)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1205382413 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:
1205382413
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:
7719 IH 35 SOUTH
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:
78239
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
210-572-2955
Provider Business Practice Location Address Fax Number:
713-637-1305
Provider Enumeration Date:
08/28/2016

Additional Information

Authorized Official

Authorized Official Last Name:
JOHNSON
Authorized Official First Name:
TINA
Authorized Official Middle Name:
Authorized Official Title or Position:
SR MED STAFF & PROVIDER ENROLLMENT
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 ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





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