Provider Demographics
NPI:1972852754
Name:TECHOTA OF TEXAS LLC
Entity Type:Organization
Organization Name:TECHOTA OF TEXAS LLC
Other - Org Name:LAKEWAY AT HOME OF AUSTIN
Other - Org Type:Doing Business As
Authorized Official - Title/Position:MANAGING MEMBER
Authorized Official - Prefix:MS
Authorized Official - First Name:PHYLLIS
Authorized Official - Middle Name:JEAN
Authorized Official - Last Name:ROBERTSON
Authorized Official - Suffix:
Authorized Official - Credentials:RN
Authorized Official - Phone:615-297-3511
Mailing Address - Street 1:176 THOMPSON LN
Mailing Address - Street 2:SUITE 103
Mailing Address - City:NASHVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37211-2448
Mailing Address - Country:US
Mailing Address - Phone:615-297-3511
Mailing Address - Fax:
Practice Address - Street 1:2802 FLINTROCK TRCE
Practice Address - Street 2:SUITE 205
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78738-1743
Practice Address - Country:US
Practice Address - Phone:615-297-3511
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-09-07
Last Update Date:2012-09-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health