Organization
LTC MANAGEMENT SUCS
Active
Organization subpart
No
Provider details
NPI number
Authorized official
JAKE HALLSTED (PRESIDENT)
(832) 448-3705
Entity
Organization
Contact information
Practice address
14800 ST. MARY'S LANE STE 175, HOUSTON, TX 77079
(832) 448-3705
Mailing address
14800 ST. MARY'S LANE STE 175, HOUSTON, TX 77079
(832) 448-3705
Taxonomy
Speciality
Code
Description
License number
State
332BP3500X
Parenteral & Enteral Nutrition Supplies (DME)
Primary
332BP3500X
TX
Other
Enumeration date
05/24/2006
Last updated
08/22/2020
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