Provider Demographics
NPI:1114975042
Name:IHG HEALTHCARE, INC
Entity Type:Organization
Organization Name:IHG HEALTHCARE, INC
Other - Org Name:GRACE HOSPIC OF TEXAS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:ROMEO
Authorized Official - Middle Name:
Authorized Official - Last Name:VILLARREAL
Authorized Official - Suffix:JR
Authorized Official - Credentials:RN
Authorized Official - Phone:281-442-8200
Mailing Address - Street 1:2325 TIMBER SHADOWS DR STE B
Mailing Address - Street 2:
Mailing Address - City:KINGWOOD
Mailing Address - State:TX
Mailing Address - Zip Code:77339-2028
Mailing Address - Country:US
Mailing Address - Phone:281-442-8200
Mailing Address - Fax:281-442-8201
Practice Address - Street 1:2325 TIMBER SHADOWS DR STE B
Practice Address - Street 2:
Practice Address - City:KINGWOOD
Practice Address - State:TX
Practice Address - Zip Code:77339-2028
Practice Address - Country:US
Practice Address - Phone:281-442-8200
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-04
Last Update Date:2019-02-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX008780251G00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251G00000XAgenciesHospice Care, Community Based
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX451755Medicare ID - Type Unspecified