Healthcare Provider Details

I. General information

NPI: 1043687908
Provider Name (Legal Business Name): BOLAD HEALTH CARE SERVICES LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/27/2015
Last Update Date: 05/22/2024
Certification Date: 05/22/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

13828 SUTHERLAND SPRING LN
ROSHARON TX
77583-2149
US

IV. Provider business mailing address

13828 SUTHERLAND SPRING LN
ROSHARON TX
77583
US

V. Phone/Fax

Practice location:
  • Phone: 719-406-9160
  • Fax:
Mailing address:
  • Phone: 346-715-6084
  • Fax: 281-595-7668

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License Number018630
License Number StateTX
# 2
Primary TaxonomyN
Taxonomy Code251G00000X
TaxonomyCommunity Based Hospice Care Agency
License Number018630
License Number StateTX
# 3
Primary TaxonomyN
Taxonomy Code253Z00000X
TaxonomyIn Home Supportive Care Agency
License Number
License Number StateTX
# 4
Primary TaxonomyN
Taxonomy Code3104A0625X
TaxonomyAssisted Living Facility (Mental Illness)
License Number
License Number State
# 5
Primary TaxonomyN
Taxonomy Code3104A0630X
TaxonomyAssisted Living Facility (Behavioral Disturbances)
License Number
License Number State
# 6
Primary TaxonomyN
Taxonomy Code311ZA0620X
TaxonomyAdult Care Home Facility
License Number
License Number State
# 7
Primary TaxonomyN
Taxonomy Code3747P1801X
TaxonomyPersonal Care Attendant
License Number
License Number State
# 8
Primary TaxonomyN
Taxonomy Code385HR2060X
TaxonomyChild Intellectual and/or Developmental Disabilities Respite Care
License Number
License Number StateTX

VIII. Authorized Official

Name: MRS. OLUBUNMI ADEBOLA OKETUNMBI
Title or Position: ADMINISTRATOR /OWNER
Credential: RN
Phone: 719-406-9160