Healthcare Provider Details

I. General information

NPI: 1124356621
Provider Name (Legal Business Name): BKCP,LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/23/2009
Last Update Date: 11/23/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

314 E HIGHLAND MALL BLVD SUITE 103
AUSTIN TX
78752-3735
US

IV. Provider business mailing address

100 LARIAT DR
GEORGETOWN TX
78633-4568
US

V. Phone/Fax

Practice location:
  • Phone: 512-610-0808
  • Fax: 512-610-0810
Mailing address:
  • Phone: 512-610-0808
  • Fax: 512-610-0810

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License Number
License Number State

VIII. Authorized Official

Name: MR. CARLEY JOHN TOBIAS
Title or Position: OWNER/CEO
Credential:
Phone: 512-610-0808