Provider Demographics
NPI:1265263479
Name:EAST TEXAS HYDRATION SOLUTIONS LLC
Entity type:Organization
Organization Name:EAST TEXAS HYDRATION SOLUTIONS LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/PARAMEDIC
Authorized Official - Prefix:MR
Authorized Official - First Name:JOSEPH
Authorized Official - Middle Name:WILLIAM
Authorized Official - Last Name:GADUS
Authorized Official - Suffix:III
Authorized Official - Credentials:IV HYDRATION
Authorized Official - Phone:832-270-6737
Mailing Address - Street 1:20125 PLANTATION CREEK DR
Mailing Address - Street 2:
Mailing Address - City:PORTER
Mailing Address - State:TX
Mailing Address - Zip Code:77365-6953
Mailing Address - Country:US
Mailing Address - Phone:832-270-6737
Mailing Address - Fax:
Practice Address - Street 1:20125 PLANTATION CREEK DR
Practice Address - Street 2:
Practice Address - City:PORTER
Practice Address - State:TX
Practice Address - Zip Code:77365-6953
Practice Address - Country:US
Practice Address - Phone:832-270-6737
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-08-09
Last Update Date:2024-08-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes171400000XOther Service ProvidersHealth & Wellness CoachGroup - Single Specialty