Healthcare Provider Details

I. General information

NPI: 1992497424
Provider Name (Legal Business Name): BKD GAINES RANCH, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/23/2023
Last Update Date: 04/28/2025
Certification Date: 04/28/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4409 GAINES RANCH LOOP
AUSTIN TX
78735-6555
US

IV. Provider business mailing address

4409 GAINES RANCH LOOP
AUSTIN TX
78735-6555
US

V. Phone/Fax

Practice location:
  • Phone: 512-721-3100
  • Fax:
Mailing address:
  • Phone: 512-721-3100
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code310400000X
TaxonomyAssisted Living Facility
License Number
License Number State

VIII. Authorized Official

Name: ANNA F.C. MUNOZ
Title or Position: ASSISTANT SECRETARY
Credential:
Phone: 414-918-5443