Provider Demographics
NPI:1508312976
Name:MANHAM ENTERPRISES LLC
Entity Type:Organization
Organization Name:MANHAM ENTERPRISES LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SOLE MEMBER
Authorized Official - Prefix:
Authorized Official - First Name:STEVE
Authorized Official - Middle Name:
Authorized Official - Last Name:WILLINGHAM
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:512-777-4092
Mailing Address - Street 1:1701 COMFORT
Mailing Address - Street 2:
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78748-3070
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:6500 RIVER PLACE BLVD
Practice Address - Street 2:BLDG 7 STE 250
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78730-1119
Practice Address - Country:US
Practice Address - Phone:512-777-4092
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-08-26
Last Update Date:2016-08-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX016519251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health