Provider Demographics
NPI:1437429065
Name:TRADITIONS HEALTH CARE OF MADISONVILLE, LLC
Entity Type:Organization
Organization Name:TRADITIONS HEALTH CARE OF MADISONVILLE, LLC
Other - Org Name:TRADITIONS HEALTH
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT & CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:R
Authorized Official - Last Name:KLEMENTZ
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:979-704-6547
Mailing Address - Street 1:150 4TH AVE N STE 2300
Mailing Address - Street 2:
Mailing Address - City:NASHVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37219-2466
Mailing Address - Country:US
Mailing Address - Phone:936-348-2707
Mailing Address - Fax:936-348-2927
Practice Address - Street 1:1613 E MAIN ST STE A
Practice Address - Street 2:
Practice Address - City:MADISONVILLE
Practice Address - State:TX
Practice Address - Zip Code:77864-2207
Practice Address - Country:US
Practice Address - Phone:936-348-2707
Practice Address - Fax:936-348-2927
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:TRADITIONS HEALTH CARE HOLDING COMPANY, LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2012-01-12
Last Update Date:2023-09-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX014718OtherTEXAS DEPT. OF AGING AND DISABILITY SERVICES- LICENSE
TX747834Medicare PIN