Provider Demographics
NPI:1639310634
Name:LTHM GROVES - OPERATIONS LLC
Entity Type:Organization
Organization Name:LTHM GROVES - OPERATIONS LLC
Other - Org Name:RENAISSANCE HOSPITAL - GROVES
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:DAMIAN
Authorized Official - Middle Name:KIRK
Authorized Official - Last Name:SOILEAU
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:832-866-1840
Mailing Address - Street 1:5500 39TH ST
Mailing Address - Street 2:
Mailing Address - City:GROVES
Mailing Address - State:TX
Mailing Address - Zip Code:77619-2905
Mailing Address - Country:US
Mailing Address - Phone:409-962-5733
Mailing Address - Fax:409-963-5202
Practice Address - Street 1:5500 39TH ST
Practice Address - Street 2:
Practice Address - City:GROVES
Practice Address - State:TX
Practice Address - Zip Code:77619-2905
Practice Address - Country:US
Practice Address - Phone:409-962-5733
Practice Address - Fax:409-963-5202
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-03-20
Last Update Date:2009-10-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX100006273R00000X, 282N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes282N00000XHospitalsGeneral Acute Care Hospital
No273R00000XHospital UnitsPsychiatric Unit
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX45S123Medicare Oscar/Certification
TX450123Medicare Oscar/Certification