MEDICARE: BOUNCE BACK HOMECARE LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	253Z00000X	In Home Supportive Care Agency

General Provider Information

NPI Number	:	1235925934
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	BOUNCE BACK HOMECARE LLC

Provider Business Mailing Address
First Line	:	214 REDSTONE LN
Second Line	:
City	:	CADDO MILLS
State	:	TX
Zip	:	75135-6581
Country	:	US
Telephone Number	:	214-552-8629
Fax Number	:

Provider Business Practice Location Address
First Line	:	501 S ELM ST STE 102
Second Line	:
City	:	ROYSE CITY
State	:	TX
Zip	:	75189-4306
Country	:	US
Telephone Number	:	214-552-8629
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	ERICA WILLIAMS
Credential	:
Telephone Number	:	214-552-8629

Provider Enumeration Date	:	04/17/2025
Last Update Date	:	04/17/2025

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