Provider Demographics
NPI:1073901476
Name:CHG HOSPITAL CONROE, LLC
Entity Type:Organization
Organization Name:CHG HOSPITAL CONROE, LLC
Other - Org Name:CORNERSTONE SPECIALTY HOSPITALS CONROE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:VICE PRESIDENT, CORPORATE SECRETARY
Authorized Official - Prefix:
Authorized Official - First Name:KATHY
Authorized Official - Middle Name:
Authorized Official - Last Name:TEAGUE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:629-253-5121
Mailing Address - Street 1:2200 ROSS AVE STE 5400
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75201-7918
Mailing Address - Country:US
Mailing Address - Phone:469-621-6700
Mailing Address - Fax:469-621-6678
Practice Address - Street 1:1500 GRAND LAKE DR
Practice Address - Street 2:
Practice Address - City:CONROE
Practice Address - State:TX
Practice Address - Zip Code:77304-2891
Practice Address - Country:US
Practice Address - Phone:936-523-1800
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-01-07
Last Update Date:2024-03-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes282E00000XHospitalsLong Term Care Hospital
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX357216601Medicaid
TX357216601Medicaid