Provider Demographics
NPI:1497790083
Name:HEARTLAND OF WEST HOUSTON TX LLC
Entity Type:Organization
Organization Name:HEARTLAND OF WEST HOUSTON TX LLC
Other - Org Name:MANORCARE HEALTH SERVICES-WEST HOUSTON
Other - Org Type:Doing Business As
Authorized Official - Title/Position:VICE PRESIDENT - REIMBURSEMENTS
Authorized Official - Prefix:MR
Authorized Official - First Name:BARRY
Authorized Official - Middle Name:A
Authorized Official - Last Name:LAZARUS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:419-252-5541
Mailing Address - Street 1:333 N SUMMIT ST
Mailing Address - Street 2:ATTN BARRY LAZARUS
Mailing Address - City:TOLEDO
Mailing Address - State:OH
Mailing Address - Zip Code:43604-1531
Mailing Address - Country:US
Mailing Address - Phone:419-252-5541
Mailing Address - Fax:419-252-5548
Practice Address - Street 1:2939 WOODLAND PARK DR
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77082-2687
Practice Address - Country:US
Practice Address - Phone:821-870-9100
Practice Address - Fax:821-558-7700
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-18
Last Update Date:2012-12-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX108939314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX001015385Medicaid
TX455756Medicare Oscar/Certification