Healthcare Provider Details

I. General information

NPI: 1336405588
Provider Name (Legal Business Name): BRENHAM HC HOLDINGS LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/02/2012
Last Update Date: 11/16/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

401 E BLUE BELL RD
BRENHAM TX
77833-2407
US

IV. Provider business mailing address

127 W BROAD ST SUITE 800
LAKE CHARLES LA
70601-4291
US

V. Phone/Fax

Practice location:
  • Phone: 979-836-6611
  • Fax:
Mailing address:
  • Phone: 337-439-6600
  • Fax: 337-439-6647

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code313M00000X
TaxonomyNursing Facility/Intermediate Care Facility
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code314000000X
TaxonomySkilled Nursing Facility
License Number134683
License Number StateTX

VIII. Authorized Official

Name: KENDALL A BROUSSARD
Title or Position: MANAGING MEMBER
Credential:
Phone: 337-439-6600