Provider Demographics
NPI:1346289170
Name:KING'S DAUGHTERS HOSPITAL ASSOCIATION
Entity Type:Organization
Organization Name:KING'S DAUGHTERS HOSPITAL ASSOCIATION
Other - Org Name:KING'S DAUGHTERS HOME HEALTH
Other - Org Type:Doing Business As
Authorized Official - Title/Position:VICE PRESIDENT/CFO
Authorized Official - Prefix:
Authorized Official - First Name:ERIC
Authorized Official - Middle Name:
Authorized Official - Last Name:LASHBROOK
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:254-771-8609
Mailing Address - Street 1:1901 SW HK DODGEN LOOP
Mailing Address - Street 2:
Mailing Address - City:TEMPLE
Mailing Address - State:TX
Mailing Address - Zip Code:76502
Mailing Address - Country:US
Mailing Address - Phone:254-742-9391
Mailing Address - Fax:254-742-9545
Practice Address - Street 1:1901 SW HK DODGEN LOOP
Practice Address - Street 2:
Practice Address - City:TEMPLE
Practice Address - State:TX
Practice Address - Zip Code:76502
Practice Address - Country:US
Practice Address - Phone:254-742-9391
Practice Address - Fax:254-742-9545
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-06
Last Update Date:2008-12-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX003015251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX104290100OtherFIRSTCARE
TX136489502Medicaid
TXHH8182OtherTRAILBLAZER HLTH ENT
TXHH8182OtherTRAILBLAZER HLTH ENT