Healthcare Provider Details

I. General information

NPI: 1952040347
Provider Name (Legal Business Name): BBLS LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/02/2022
Last Update Date: 06/02/2022
Certification Date: 06/02/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

895 DOVE ST FL 3
NEWPORT BEACH CA
92660-2941
US

IV. Provider business mailing address

21163 NEWPORT COAST DR STE 155
NEWPORT BEACH CA
92657-1123
US

V. Phone/Fax

Practice location:
  • Phone: 949-535-1111
  • Fax:
Mailing address:
  • Phone: 949-535-1111
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code253Z00000X
TaxonomyIn Home Supportive Care Agency
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code385H00000X
TaxonomyRespite Care
License Number
License Number State

VIII. Authorized Official

Name: TED SCHULTE
Title or Position: PRESIDENT
Credential:
Phone: 949-535-1111