Provider Demographics
NPI:1982706735
Name:HSMTX/CLEVELAND, LLC
Entity Type:Organization
Organization Name:HSMTX/CLEVELAND, LLC
Other - Org Name:CLEVELAND HEALTH CARE CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:BOARD MEMBER/GENERAL COUNSEL
Authorized Official - Prefix:
Authorized Official - First Name:WILLIAM
Authorized Official - Middle Name:H
Authorized Official - Last Name:NEELY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:615-896-1191
Mailing Address - Street 1:13415 MEDICAL COMPLEX DR STE 101
Mailing Address - Street 2:
Mailing Address - City:TOMBALL
Mailing Address - State:TX
Mailing Address - Zip Code:77375-6441
Mailing Address - Country:US
Mailing Address - Phone:832-843-5038
Mailing Address - Fax:832-843-5050
Practice Address - Street 1:903 E HOUSTON ST
Practice Address - Street 2:
Practice Address - City:CLEVELAND
Practice Address - State:TX
Practice Address - Zip Code:77327
Practice Address - Country:US
Practice Address - Phone:281-593-3737
Practice Address - Fax:281-593-3762
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-02
Last Update Date:2018-05-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX116484314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX160203901OtherTEXAS PROVIDER IDENTIFIER
455952OtherMEDICARE OSCAR/CERTIFICATION
TX001004448Medicaid