Provider Demographics
NPI:1275576894
Name:LIVING CENTERS OF TEXAS, INC.
Entity Type:Organization
Organization Name:LIVING CENTERS OF TEXAS, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EVP, GENERAL COUNSEL
Authorized Official - Prefix:
Authorized Official - First Name:DEVIN
Authorized Official - Middle Name:M
Authorized Official - Last Name:EHRLICH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:678-443-6772
Mailing Address - Street 1:5300 W SAM HOUSTON PKWY N
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77041-5161
Mailing Address - Country:US
Mailing Address - Phone:832-467-6000
Mailing Address - Fax:
Practice Address - Street 1:5300 W SAM HOUSTON PKWY N
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77041-5161
Practice Address - Country:US
Practice Address - Phone:832-467-6000
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-13
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX004305314000000X
TX11618314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX4305-TXMedicaid
TX4401-TXMedicaid
TX4340-TXMedicaid
TX4305-TXMedicaid
TX67-5234Medicare ID - Type UnspecifiedWOODLAKE-MEDICARE
TX4401-TXMedicaid