1386943124 NPI number — TCGHHA, LLC

Table of content: (NPI 1386943124)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1386943124 NPI number — TCGHHA, LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
TCGHHA, 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:
1386943124
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
02/12/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
400 INTERSTATE NORTH PARKWAY, SE
Provider Second Line Business Mailing Address:
SUITE 1600 ATTN: LICENSING
Provider Business Mailing Address City Name:
ATLANTA
Provider Business Mailing Address State Name:
GA
Provider Business Mailing Address Postal Code:
30339
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
770-248-8740
Provider Business Mailing Address Fax Number:
770-248-8192

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
9220 KIRBY DRIVE
Provider Second Line Business Practice Location Address:
SUITE 1000
Provider Business Practice Location Address City Name:
HOUSTON
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
77054
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
713-383-9700
Provider Business Practice Location Address Fax Number:
713-383-9795
Provider Enumeration Date:
03/18/2011

Additional Information

Authorized Official

Authorized Official Last Name:
WHITESIDE
Authorized Official First Name:
VICKI
Authorized Official Middle Name:
Authorized Official Title or Position:
DIRECTOR REGULATORY LICENSING
Authorized Official Telephone Number:
770-248-8740

Provider Taxonomy Codes

  • Taxonomy code: 251E00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 261QR0400X , with the licence number: 016935 , 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: 3363517 01 , issued by the state of ( TX ) . This identifiers is of the category "MEDICAID".




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