Provider Demographics
NPI:1689672198
Name:IHS AQUISITION NO 139 INC
Entity Type:Organization
Organization Name:IHS AQUISITION NO 139 INC
Other - Org Name:PARKWOOD PLACE HEALTHCARE CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CFO
Authorized Official - Prefix:MR
Authorized Official - First Name:TIM
Authorized Official - Middle Name:
Authorized Official - Last Name:TRYBUS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:443-539-2354
Mailing Address - Street 1:300 N BYNUM ST
Mailing Address - Street 2:
Mailing Address - City:LUFKIN
Mailing Address - State:TX
Mailing Address - Zip Code:75904-2707
Mailing Address - Country:US
Mailing Address - Phone:936-637-7215
Mailing Address - Fax:936-637-2368
Practice Address - Street 1:300 N BYNUM ST
Practice Address - Street 2:
Practice Address - City:LUFKIN
Practice Address - State:TX
Practice Address - Zip Code:75904-2707
Practice Address - Country:US
Practice Address - Phone:936-637-7215
Practice Address - Fax:936-637-2368
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-07-08
Last Update Date:2013-01-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX129905314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX000521503Medicaid
TX5215Medicaid
TX000521503Medicaid