Provider Demographics
NPI:1881461846
Name:PROVISIONS HEALTH SOLUTIONS LLC
Entity type:Organization
Organization Name:PROVISIONS HEALTH SOLUTIONS LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:LA TASHA
Authorized Official - Middle Name:NICHOLE
Authorized Official - Last Name:KRAUTH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:346-473-5945
Mailing Address - Street 1:5445 ALMEDA RD STE 305
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77004-7447
Mailing Address - Country:US
Mailing Address - Phone:832-930-4133
Mailing Address - Fax:
Practice Address - Street 1:5445 ALMEDA RD STE 305
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77004-7447
Practice Address - Country:US
Practice Address - Phone:832-930-4133
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-12-08
Last Update Date:2024-06-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty
No261QM0850XAmbulatory Health Care FacilitiesClinic/CenterAdult Mental HealthGroup - Multi-Specialty
No261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary CareGroup - Multi-Specialty