Provider Demographics
NPI:1609144682
Name:THIRTEEN LAC, INC.
Entity Type:Organization
Organization Name:THIRTEEN LAC, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:
Authorized Official - Last Name:MAINGUY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:410-770-9930
Mailing Address - Street 1:8161 TEAL DRIVE STE 201
Mailing Address - Street 2:
Mailing Address - City:EASTON
Mailing Address - State:MD
Mailing Address - Zip Code:21601
Mailing Address - Country:US
Mailing Address - Phone:410-770-9930
Mailing Address - Fax:410-770-9930
Practice Address - Street 1:10300 N CENTRAL EXPY
Practice Address - Street 2:STE 324
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75231-8600
Practice Address - Country:US
Practice Address - Phone:214-265-5055
Practice Address - Fax:214-265-5995
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:AUGUSTINE HOME HEALTH CARE INC.
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2011-12-06
Last Update Date:2011-12-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX11457251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health