Provider Demographics
NPI:1962491662
Name:ANAHUAC HEALTHCARE CENTER
Entity Type:Organization
Organization Name:ANAHUAC HEALTHCARE CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BUSINESS OFFICE MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:CINDY
Authorized Official - Middle Name:
Authorized Official - Last Name:RANDLE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:409-267-3164
Mailing Address - Street 1:PO BOX W
Mailing Address - Street 2:
Mailing Address - City:ANAHUAC
Mailing Address - State:TX
Mailing Address - Zip Code:77514-1723
Mailing Address - Country:US
Mailing Address - Phone:409-267-3164
Mailing Address - Fax:409-267-3764
Practice Address - Street 1:300 HOSPITAL DRIVE
Practice Address - Street 2:
Practice Address - City:ANAHUAC
Practice Address - State:TX
Practice Address - Zip Code:77514-1723
Practice Address - Country:US
Practice Address - Phone:409-267-3164
Practice Address - Fax:409-267-3764
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-10-17
Last Update Date:2008-06-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX112909314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX000490106Medicaid
TX455710Medicare ID - Type UnspecifiedFACILITY PROVIDER NUMBER