Healthcare Provider Details

I. General information

NPI: 1275140014
Provider Name (Legal Business Name): BRENDA BURFORD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/25/2020
Last Update Date: 09/25/2020
Certification Date: 09/11/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

405 E HONDO AVE
DEVINE TX
78016-3316
US

IV. Provider business mailing address

PO BOX 224
DEVINE TX
78016-0224
US

V. Phone/Fax

Practice location:
  • Phone: 210-387-7515
  • Fax: 830-665-2033
Mailing address:
  • Phone: 210-387-7515
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code3104A0625X
TaxonomyAssisted Living Facility (Mental Illness)
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: