1871688309 NPI number — THE WOODLANDS HEALTHCARE CENTER, L.L.C.

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 1871688309 NPI number — THE WOODLANDS HEALTHCARE CENTER, L.L.C.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
THE WOODLANDS HEALTHCARE CENTER, L.L.C.
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:
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:
1871688309
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
10/18/2018
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
144 THAD BILLS DRIVE
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
LEESVILLE
Provider Business Mailing Address State Name:
LA
Provider Business Mailing Address Postal Code:
71446-2832
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
337-239-6578
Provider Business Mailing Address Fax Number:
337-238-2723

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
144 THAD BAILS ROAD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
LEESVILLE
Provider Business Practice Location Address State Name:
LA
Provider Business Practice Location Address Postal Code:
71446
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
337-239-6578
Provider Business Practice Location Address Fax Number:
337-238-2723
Provider Enumeration Date:
10/03/2006

Additional Information

Authorized Official

Authorized Official Last Name:
TITMAN
Authorized Official First Name:
RACHAEL
Authorized Official Middle Name:
MICHELLE
Authorized Official Title or Position:
DIRECTOR OF REVENUE CYCLE
Authorized Official Telephone Number:
972-428-0876

Provider Taxonomy Codes

  • Taxonomy code: 314000000X , with the licence number:  883 , registered in the state of LA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 1510891 , issued by the state of ( LA ) . This identifiers is of the category "MEDICAID".




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