Provider Demographics
NPI:1336539196
Name:LONG LIFE HEALTHCARE OF TEXAS LLC
Entity Type:Organization
Organization Name:LONG LIFE HEALTHCARE OF TEXAS LLC
Other - Org Name:LONG LIFE HEALTHCARE OF TEXAS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:ALTERNATE ADMINISTRATOR
Authorized Official - Prefix:MS
Authorized Official - First Name:VERONICA
Authorized Official - Middle Name:
Authorized Official - Last Name:MARISCAL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:832-649-5947
Mailing Address - Street 1:8866 GULF FWY STE 400F
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77017-6514
Mailing Address - Country:US
Mailing Address - Phone:832-649-5947
Mailing Address - Fax:832-767-1396
Practice Address - Street 1:8866 GULF FRWY, SUITE 400F
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77017-4412
Practice Address - Country:US
Practice Address - Phone:832-649-5947
Practice Address - Fax:832-767-1396
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-02-02
Last Update Date:2016-10-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253Z00000XAgenciesIn Home Supportive Care