Provider Demographics
NPI:1992807747
Name:HMSTX/HUNTSVILLE LLC
Entity type:Organization
Organization Name:HMSTX/HUNTSVILLE LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:JOSHUA
Authorized Official - Middle Name:LEN
Authorized Official - Last Name:WHITE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:832-843-5038
Mailing Address - Street 1:2628 MILAM ST
Mailing Address - Street 2:
Mailing Address - City:HUNTSVILLE
Mailing Address - State:TX
Mailing Address - Zip Code:77340-6615
Mailing Address - Country:US
Mailing Address - Phone:936-293-8062
Mailing Address - Fax:
Practice Address - Street 1:2628 MILAM ST
Practice Address - Street 2:
Practice Address - City:HUNTSVILLE
Practice Address - State:TX
Practice Address - Zip Code:77340
Practice Address - Country:US
Practice Address - Phone:936-293-8062
Practice Address - Fax:936-291-7384
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-02
Last Update Date:2024-01-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX116483314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX159508401OtherTEXAS PROVIDER IDENTIFIER
TX001004449Medicaid
TX159508401OtherTEXAS PROVIDER IDENTIFIER