Provider Demographics
NPI:1033107826
Name:INTRACARE HOSPITAL NORTH
Entity Type:Organization
Organization Name:INTRACARE HOSPITAL NORTH
Other - Org Name:INTRACARE NORTH HOSPITAL
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CEO, HEALTHCARE OPERATIONS
Authorized Official - Prefix:MR
Authorized Official - First Name:TERRY
Authorized Official - Middle Name:
Authorized Official - Last Name:SCOVILL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:281-893-7200
Mailing Address - Street 1:1120 CYPRESS STATION DR
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77090-3002
Mailing Address - Country:US
Mailing Address - Phone:281-893-7200
Mailing Address - Fax:281-583-0137
Practice Address - Street 1:1120 CYPRESS STATION DR
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77090-3002
Practice Address - Country:US
Practice Address - Phone:281-893-7200
Practice Address - Fax:281-583-0137
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-10-06
Last Update Date:2013-10-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX782283Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes283Q00000XHospitalsPsychiatric Hospital
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX021247401Medicaid
TX094381301Medicaid
TX021247401Medicaid