=====================================================
General NPI Number Information
=====================================================
NPI Number | 1215460373
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | BV TEXAS HOME CARE LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 04/06/2017
-----------------------------------------------------
Last Update Date | 04/06/2017
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 983 WHITEHEAD DR SUITE 102
-----------------------------------------------------
City | GRANBURY
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 76048-1463
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 682-205-3366
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 983 WHITEHEAD DR SUITE 102
-----------------------------------------------------
City | GRANBURY
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 76048-1463
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone |
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | DIRECTOR
-----------------------------------------------------
Name | LORI GONZALEZ
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 951-201-4056
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 253Z00000X
-----------------------------------------------------
Taxonomy Name | In Home Supportive Care Agency
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------