Provider Demographics
NPI:1508873696
Name:R L TOMS INC
Entity Type:Organization
Organization Name:R L TOMS INC
Other - Org Name:LIVE OAK MEDICAL CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:REGIONAL ADMINISTRATOR DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:LYNDI
Authorized Official - Middle Name:
Authorized Official - Last Name:ACHILLES
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:830-833-4567
Mailing Address - Street 1:PO BOX 356
Mailing Address - Street 2:
Mailing Address - City:BLANCO
Mailing Address - State:TX
Mailing Address - Zip Code:78606-0356
Mailing Address - Country:US
Mailing Address - Phone:830-833-4567
Mailing Address - Fax:830-833-0466
Practice Address - Street 1:618 LIVE OAK ST
Practice Address - Street 2:
Practice Address - City:BLANCO
Practice Address - State:TX
Practice Address - Zip Code:78606-9998
Practice Address - Country:US
Practice Address - Phone:830-833-4567
Practice Address - Fax:830-833-0466
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:R L TOMS INC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2006-08-02
Last Update Date:2008-07-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX115368313M00000X
TX121827313M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes313M00000XNursing & Custodial Care FacilitiesNursing Facility/Intermediate Care Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX000434202Medicaid