Provider Demographics
NPI:1386943124
Name:TCGHHA, LLC
Entity type:Organization
Organization Name:TCGHHA, LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR REGULATORY LICENSING
Authorized Official - Prefix:
Authorized Official - First Name:VICKI
Authorized Official - Middle Name:
Authorized Official - Last Name:WHITESIDE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:770-248-8740
Mailing Address - Street 1:400 INTERSTATE NORTH PARKWAY, SE
Mailing Address - Street 2:SUITE 1600 ATTN: LICENSING
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30339
Mailing Address - Country:US
Mailing Address - Phone:770-248-8740
Mailing Address - Fax:770-248-8192
Practice Address - Street 1:9220 KIRBY DRIVE
Practice Address - Street 2:SUITE 1000
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77054
Practice Address - Country:US
Practice Address - Phone:713-383-9700
Practice Address - Fax:713-383-9795
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-03-18
Last Update Date:2020-02-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
251E00000X
TX016935261QR0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
No261QR0400XAmbulatory Health Care FacilitiesClinic/CenterRehabilitation
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX3363517 01Medicaid