Provider Demographics
NPI:1831387505
Name:ST. MARTIN HEALTHCARE SERVICES, LLC
Entity type:Organization
Organization Name:ST. MARTIN HEALTHCARE SERVICES, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MR
Authorized Official - First Name:RICARDO
Authorized Official - Middle Name:A
Authorized Official - Last Name:TANUECO
Authorized Official - Suffix:JR
Authorized Official - Credentials:RN, BSN
Authorized Official - Phone:713-771-5553
Mailing Address - Street 1:6100 CORPORATE DRIVE
Mailing Address - Street 2:SUITE 515
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77036
Mailing Address - Country:US
Mailing Address - Phone:713-771-5553
Mailing Address - Fax:713-771-5090
Practice Address - Street 1:6100 CORPORATE DRIVE
Practice Address - Street 2:SUITE 515
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77036
Practice Address - Country:US
Practice Address - Phone:713-771-5553
Practice Address - Fax:713-771-5090
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-10-09
Last Update Date:2015-02-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX011346251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health