Provider Demographics
NPI:1144662776
Name:ALAMO THERAPY GROUP, LLC
Entity type:Organization
Organization Name:ALAMO THERAPY GROUP, LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:TAYLOR
Authorized Official - Middle Name:J
Authorized Official - Last Name:KOVAR
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:936-465-4110
Mailing Address - Street 1:415 S 1ST ST STE 300A
Mailing Address - Street 2:
Mailing Address - City:LUFKIN
Mailing Address - State:TX
Mailing Address - Zip Code:75901-3863
Mailing Address - Country:US
Mailing Address - Phone:832-539-1632
Mailing Address - Fax:832-539-1633
Practice Address - Street 1:415 S 1ST ST STE 300A
Practice Address - Street 2:
Practice Address - City:LUFKIN
Practice Address - State:TX
Practice Address - Zip Code:75901-3863
Practice Address - Country:US
Practice Address - Phone:832-539-1632
Practice Address - Fax:832-539-1633
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-07-24
Last Update Date:2019-12-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX015955Medicaid
TX019552Medicaid