Provider Demographics
NPI:1154375129
Name:CHCA BAYSHORE LP
Entity type:Organization
Organization Name:CHCA BAYSHORE LP
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CFO
Authorized Official - Prefix:
Authorized Official - First Name:WAYNE
Authorized Official - Middle Name:KENT
Authorized Official - Last Name:GORDON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:713-359-1006
Mailing Address - Street 1:4000 SPENCER HWY
Mailing Address - Street 2:
Mailing Address - City:PASADENA
Mailing Address - State:TX
Mailing Address - Zip Code:77504-1202
Mailing Address - Country:US
Mailing Address - Phone:713-359-1000
Mailing Address - Fax:713-359-1004
Practice Address - Street 1:4000 SPENCER HWY
Practice Address - Street 2:
Practice Address - City:PASADENA
Practice Address - State:TX
Practice Address - Zip Code:77504-1202
Practice Address - Country:US
Practice Address - Phone:713-359-1000
Practice Address - Fax:713-359-1004
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:CHCA BAYSHORE LP
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2006-05-22
Last Update Date:2022-11-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes273Y00000XHospital UnitsRehabilitation Unit
Provider Identifiers
StateIdentifier IDID TypeIssuer
45T097Medicare Oscar/Certification