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General NPI Number Information
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NPI Number | 1891277943
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Entity Type | Organization
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Legal Business Name | BANT HOLDINGS LLC
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Dates
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Enumeration Date | 09/05/2018
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Last Update Date | 09/05/2018
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Provider Practice Location Address
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Address Line | 5900 S LAKE FOREST DR STE 300
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City | MCKINNEY
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State | TX
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Zip | 75070-2238
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Country | US
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Telephone | 469-342-8750
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Fax | 469-342-8751
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Provider Business Mailing Address
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Address Line | 5900 S LAKE FOREST DR STE 300
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City | MCKINNEY
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State | TX
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Zip | 75070-2238
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Country | US
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Telephone | 469-342-8750
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Fax | 469-342-8751
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Authorized Official
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Title or Position | OWNER/ADMINISTRATOR
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Name | MRS. TERRI JEAN VAN STAVERN
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Credential | RN
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Telephone | 469-342-8750
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 253Z00000X
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Taxonomy Name | In Home Supportive Care Agency
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License Number | 018734
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License Number State | TX
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