Provider Demographics
NPI:1780629279
Name:HMS HOLDINGS AT TEXARKANA LLC
Entity Type:Organization
Organization Name:HMS HOLDINGS AT TEXARKANA LLC
Other - Org Name:CHRISTIAN CARE CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:JAKE
Authorized Official - Middle Name:
Authorized Official - Last Name:HALLSTED
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:832-448-3700
Mailing Address - Street 1:1008 CITIZENS TRAIL
Mailing Address - Street 2:
Mailing Address - City:TEXARKANA
Mailing Address - State:TX
Mailing Address - Zip Code:75501-5884
Mailing Address - Country:US
Mailing Address - Phone:903-838-9526
Mailing Address - Fax:903-831-7697
Practice Address - Street 1:1008 CITIZENS TRAIL
Practice Address - Street 2:
Practice Address - City:TEXARKANA
Practice Address - State:TX
Practice Address - Zip Code:75501-5884
Practice Address - Country:US
Practice Address - Phone:903-838-9526
Practice Address - Fax:903-831-7697
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:HEALTHLINK HOLDINGS GROUP LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2006-06-18
Last Update Date:2014-06-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX105840314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX001004288Medicaid
TX001004288Medicaid