Healthcare Provider Details

I. General information

NPI: 1689781163
Provider Name (Legal Business Name): BIG BEND HOME CARE SERVICES LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/23/2006
Last Update Date: 10/21/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2600 N HIGHWAY 118
ALPINE TX
79830-2002
US

IV. Provider business mailing address

2600 N HIGHWAY 118
ALPINE TX
79830-2002
US

V. Phone/Fax

Practice location:
  • Phone: 432-837-3467
  • Fax: 432-837-0077
Mailing address:
  • Phone: 432-837-3467
  • Fax: 432-837-0077

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License Number007266
License Number StateTX

VIII. Authorized Official

Name: LAURIE HOLTSFORD
Title or Position: DIRECTOR OF BUSINESS OFFICE SUPPORT
Credential:
Phone: 615-465-7466