Healthcare Provider Details

I. General information

NPI: 1962682831
Provider Name (Legal Business Name): BMW ENTERPRISE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/08/2007
Last Update Date: 11/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1340A 280TH AVE
HAYS KS
67601-9753
US

IV. Provider business mailing address

1340A 280TH AVE
HAYS KS
67601-9753
US

V. Phone/Fax

Practice location:
  • Phone: 785-625-0015
  • Fax: 785-625-0015
Mailing address:
  • Phone: 785-625-0015
  • Fax: 785-625-0015

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251C00000X
TaxonomyDevelopmentally Disabled Services Day Training Agency
License Number200516660A
License Number StateKS
# 2
Primary TaxonomyN
Taxonomy Code3747P1801X
TaxonomyPersonal Care Attendant
License Number200516660A
License Number StateKS

VIII. Authorized Official

Name: MR. JOSEPH M BOECKNER
Title or Position: CEO
Credential:
Phone: 785-625-0015