Provider Demographics
NPI:1093792111
Name:INTER ACTIVE HEALTHCARE INC
Entity Type:Organization
Organization Name:INTER ACTIVE HEALTHCARE INC
Other - Org Name:INTER ACTIVE HOSPICE SERVICES
Other - Org Type:Doing Business As
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:LEIGH
Authorized Official - Middle Name:
Authorized Official - Last Name:NARVACAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:281-892-2000
Mailing Address - Street 1:4677 TECHNIPLEX DR
Mailing Address - Street 2:
Mailing Address - City:STAFFORD
Mailing Address - State:TX
Mailing Address - Zip Code:77477-3825
Mailing Address - Country:US
Mailing Address - Phone:281-892-2000
Mailing Address - Fax:281-892-2015
Practice Address - Street 1:4677 TECHNIPLEX DR
Practice Address - Street 2:
Practice Address - City:STAFFORD
Practice Address - State:TX
Practice Address - Zip Code:77477-3825
Practice Address - Country:US
Practice Address - Phone:281-892-2000
Practice Address - Fax:281-892-2015
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-12-29
Last Update Date:2019-02-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX007458251G00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251G00000XAgenciesHospice Care, Community Based
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX000218100Medicaid
TXHH6881OtherBCBS