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General NPI Number Information
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NPI Number | 1992219430
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Entity Type | Organization
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Legal Business Name | BOUDINE & ASSOCIATES, LLC
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Dates
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Enumeration Date | 11/20/2017
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Last Update Date | 03/14/2018
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Provider Practice Location Address
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Address Line | 2406 DAWN DR
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City | GEORGETOWN
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State | TX
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Zip | 78628-3314
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Country | US
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Telephone | 512-942-5284
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Fax |
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Provider Business Mailing Address
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Address Line | 633 PINNACLE DR
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City | GEORGETOWN
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State | TX
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Zip | 78626-8217
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Country | US
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Telephone | 512-809-9944
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Fax |
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Authorized Official
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Title or Position | OPERATING OWNER
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Name | BO DONOHOO
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Credential | LTC, MBA, PMP
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Telephone | 512-809-9944
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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 |
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License Number State | TX
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