Provider Demographics
NPI:1205189172
Name:EMERUS BHS SA THOUSAND OAKS, LLC
Entity Type:Organization
Organization Name:EMERUS BHS SA THOUSAND OAKS, LLC
Other - Org Name:BAPTIST NEIGHBORHOOD HOSPITAL OVERLOOK
Other - Org Type:Doing Business As
Authorized Official - Title/Position:SR MED STAFF & PROVIDER ENROLLMENT
Authorized Official - Prefix:
Authorized Official - First Name:TINA
Authorized Official - Middle Name:
Authorized Official - Last Name:JOHNSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:713-637-1146
Mailing Address - Street 1:8686 NEW TRAILS DR
Mailing Address - Street 2:SUITE 100
Mailing Address - City:THE WOODLANDS
Mailing Address - State:TX
Mailing Address - Zip Code:77381-1176
Mailing Address - Country:US
Mailing Address - Phone:713-637-1044
Mailing Address - Fax:
Practice Address - Street 1:25615 N US HIGHWAY 281
Practice Address - Street 2:
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78258-7118
Practice Address - Country:US
Practice Address - Phone:713-637-1044
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:BHS SA THOUSAND OAKS, LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2012-10-17
Last Update Date:2021-02-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes282N00000XHospitalsGeneral Acute Care Hospital
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX309798201Medicaid
TX309798201Medicaid