=====================================================
General NPI Number Information
=====================================================
NPI Number | 1194753590
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | THHBP MANAGEMENT COMPANY LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 06/28/2006
-----------------------------------------------------
Last Update Date | 01/22/2020
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 2801 S MAYHILL RD
-----------------------------------------------------
City | DENTON
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 76208-5910
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 940-220-0600
-----------------------------------------------------
Fax | 940-220-0605
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | PO BOX 844750
-----------------------------------------------------
City | DALLAS
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 75284-4750
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 214-820-6710
-----------------------------------------------------
Fax | 214-820-7950
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | CEO
-----------------------------------------------------
Name | MARK ALLEN VALENTINE
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 469-814-3511
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 282N00000X
-----------------------------------------------------
Taxonomy Name | General Acute Care Hospital
-----------------------------------------------------
License Number | 100208
-----------------------------------------------------
License Number State | TX
-----------------------------------------------------