Healthcare Provider Details

I. General information

NPI: 1235241357
Provider Name (Legal Business Name): REDMAN BOARDING HOME
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/31/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

850 COUNTY ROAD 6612
DEVINE TX
78016-4161
US

IV. Provider business mailing address

850 COUNTY ROAD 6612
DEVINE TX
78016-4161
US

V. Phone/Fax

Practice location:
  • Phone: 830-665-9678
  • Fax: 830-665-9678
Mailing address:
  • Phone: 830-665-9678
  • Fax: 830-665-9678

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code310400000X
TaxonomyAssisted Living Facility
License Number117604
License Number StateTX

VIII. Authorized Official

Name: IRMA REDMAN
Title or Position: OWNER
Credential:
Phone: 830-665-9678