Provider Demographics
NPI:1033520531
Name:RESOLUTE HOSPITAL COMPANY LLC
Entity Type:Organization
Organization Name:RESOLUTE HOSPITAL COMPANY LLC
Other - Org Name:THE BRANCHES AT RESOLUTE HEALTH
Other - Org Type:Doing Business As
Authorized Official - Title/Position:DIRECTOR OF PHARMACY
Authorized Official - Prefix:
Authorized Official - First Name:STEWART
Authorized Official - Middle Name:
Authorized Official - Last Name:WIREBAUGH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:830-500-6761
Mailing Address - Street 1:555 CREEKSIDE XING
Mailing Address - Street 2:
Mailing Address - City:NEW BRAUNFELS
Mailing Address - State:TX
Mailing Address - Zip Code:78130-2594
Mailing Address - Country:US
Mailing Address - Phone:830-500-6761
Mailing Address - Fax:
Practice Address - Street 1:555 CREEKSIDE XING
Practice Address - Street 2:
Practice Address - City:NEW BRAUNFELS
Practice Address - State:TX
Practice Address - Zip Code:78130-2594
Practice Address - Country:US
Practice Address - Phone:830-500-6761
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-05-19
Last Update Date:2014-06-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX292083336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
2146062OtherPK