Provider Demographics
NPI:1548685159
Name:HEALTHCARE WAREHOUSE, LLC
Entity type:Organization
Organization Name:HEALTHCARE WAREHOUSE, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:TODD
Authorized Official - Middle Name:O
Authorized Official - Last Name:BROCK
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:409-670-9979
Mailing Address - Street 1:1301 MARTIN LUTHER KING JR DR STE A
Mailing Address - Street 2:
Mailing Address - City:ORANGE
Mailing Address - State:TX
Mailing Address - Zip Code:77630-9000
Mailing Address - Country:US
Mailing Address - Phone:409-670-9979
Mailing Address - Fax:409-670-9984
Practice Address - Street 1:1301 MARTIN LUTHER KING JR DR STE A
Practice Address - Street 2:
Practice Address - City:ORANGE
Practice Address - State:TX
Practice Address - Zip Code:77630-9000
Practice Address - Country:US
Practice Address - Phone:409-670-9979
Practice Address - Fax:409-670-9984
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-02-19
Last Update Date:2020-12-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX336531402Medicaid
TX336531401Medicaid
TX336531402Medicaid