Provider Demographics
NPI:1689921983
Name:LX HOMECARE, LLC
Entity Type:Organization
Organization Name:LX HOMECARE, LLC
Other - Org Name:NW-ACP
Other - Org Type:Doing Business As
Authorized Official - Title/Position:MANAGING OFFICER, AO
Authorized Official - Prefix:
Authorized Official - First Name:ISSAM
Authorized Official - Middle Name:
Authorized Official - Last Name:KHEIRBECK
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:281-602-3787
Mailing Address - Street 1:800 PEAKWOOD DR STE 4A
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77090-2914
Mailing Address - Country:US
Mailing Address - Phone:281-602-3487
Mailing Address - Fax:281-781-8442
Practice Address - Street 1:800 PEAKWOOD DR
Practice Address - Street 2:STE 4-A
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77090
Practice Address - Country:US
Practice Address - Phone:281-602-3487
Practice Address - Fax:281-781-8442
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:ASSURANCE CONSOLIDATED PHARMACY
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2012-08-07
Last Update Date:2018-12-03
Deactivation Date:2018-11-06
Deactivation Code:
Reactivation Date:2018-12-03
Provider Licenses
StateLicense IDTaxonomies
333600000X, 3336C0004X
TX277343336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No333600000XSuppliersPharmacy
No3336C0004XSuppliersPharmacyCompounding Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX146598Medicaid
2136189OtherPK