Healthcare Provider Details

I. General information

NPI: 1609322825
Provider Name (Legal Business Name): BENBROOK SENIOR CARE, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/28/2016
Last Update Date: 08/28/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1000 MCKINLEY STREET
BENBROOK TX
76126
US

IV. Provider business mailing address

PO BOX 23648
WACO TX
76702
US

V. Phone/Fax

Practice location:
  • Phone: 254-741-5929
  • Fax: 254-741-5928
Mailing address:
  • Phone: 254-741-5929
  • Fax: 254-741-5928

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code314000000X
TaxonomySkilled Nursing Facility
License Number
License Number StateTX

VIII. Authorized Official

Name: MICHAEL BUMPASS
Title or Position: MEMBER
Credential:
Phone: 254-741-5929