Provider Demographics
NPI:1609876309
Name:TRIUMPH HOSPITAL OF EAST HOUSTON, LP
Entity Type:Organization
Organization Name:TRIUMPH HOSPITAL OF EAST HOUSTON, LP
Other - Org Name:KINDRED HOSPITAL CLEAR LAKE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:VICE PRESIDENT, CORPORATE SECRETARY
Authorized Official - Prefix:
Authorized Official - First Name:KATHY
Authorized Official - Middle Name:
Authorized Official - Last Name:TEAGUE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:629-253-5121
Mailing Address - Street 1:350 BLOSSOM ST
Mailing Address - Street 2:
Mailing Address - City:WEBSTER
Mailing Address - State:TX
Mailing Address - Zip Code:77598-4206
Mailing Address - Country:US
Mailing Address - Phone:281-316-7800
Mailing Address - Fax:281-316-7828
Practice Address - Street 1:350 BLOSSOM ST
Practice Address - Street 2:
Practice Address - City:WEBSTER
Practice Address - State:TX
Practice Address - Zip Code:77598-4206
Practice Address - Country:US
Practice Address - Phone:281-316-7800
Practice Address - Fax:281-316-7828
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-07-26
Last Update Date:2024-03-11
Deactivation Date:2016-11-22
Deactivation Code:
Reactivation Date:2016-12-02
Provider Licenses
StateLicense IDTaxonomies
TX007204282E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes282E00000XHospitalsLong Term Care Hospital
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXHH1006OtherBLUE CROSS
TX149047601Medicaid
452075Medicare Oscar/Certification