Provider Demographics
NPI:1558851394
Name:WOODLANDS INTEGRATIVE CARE HOSPITAL
Entity Type:Organization
Organization Name:WOODLANDS INTEGRATIVE CARE HOSPITAL
Other - Org Name:WOODLANDS INTEGRATIVE CARE HOSPITAL
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MRS
Authorized Official - First Name:MARYJO
Authorized Official - Middle Name:
Authorized Official - Last Name:NAZER
Authorized Official - Suffix:
Authorized Official - Credentials:MSN, RN
Authorized Official - Phone:281-292-7246
Mailing Address - Street 1:1006 WINDSOR LAKE BLVD.
Mailing Address - Street 2:SUITE 200
Mailing Address - City:CONROE
Mailing Address - State:TX
Mailing Address - Zip Code:77384
Mailing Address - Country:US
Mailing Address - Phone:281-292-7246
Mailing Address - Fax:281-292-3996
Practice Address - Street 1:1006 WINDSOR LAKE BLVD.
Practice Address - Street 2:SUITE 200
Practice Address - City:CONROE
Practice Address - State:TX
Practice Address - Zip Code:77384
Practice Address - Country:US
Practice Address - Phone:281-292-7246
Practice Address - Fax:281-292-3996
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-05-17
Last Update Date:2018-08-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX100445283Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes283Q00000XHospitalsPsychiatric Hospital
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX100445OtherTEXAS DEPARTMENT OF STATE HEALTH SERVICES HOSPITAL LICENSE