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NPI Code Detail

MEDICARE: BOUNTIFUL COMMUNITY HOME HEALTH L.L.C.

MEDICARE: BOUNTIFUL COMMUNITY HOME HEALTH L.L.C.
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1251S00000XCommunity/Behavioral Health Agency
2253Z00000XIn Home Supportive Care Agency
3253Z00000XIn Home Supportive Care AgencyTX

General Provider Information

NPI Number : 1316471436
Entity Type Code : Organization
Provider Name (Legal Business Name) : BOUNTIFUL COMMUNITY HOME HEALTH L.L.C.
Provider Business Mailing Address
First Line : 5601 BRIDGE STREET
Second Line : 300
City : FORT WORTH
State : TX
Zip : 76112-2355
Country : US
Telephone Number : 817-586-4314
Fax Number : 817-489-9174
Provider Business Practice Location Address
First Line : 5601 BRIDGE ST STE 300
Second Line :
City : FORT WORTH
State : TX
Zip : 76112-2355
Country : US
Telephone Number : 817-586-4314
Fax Number : 817-489-9174
Authorized Official
Title or Position : OWNER/ADMINISTRATOR
Name : MS. TIMIERA CHANTEL CLARK
Credential : S.C.O.T.A
Telephone Number : 817-902-8085
Provider Enumeration Date : 04/14/2017
Last Update Date : 08/22/2019

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Directions to “BOUNTIFUL COMMUNITY HOME HEALTH L.L.C. ” Practice Location

Language Start Address Practice Location
These directions are for planning purposes only. You may find that construction projects, traffic, or other events may cause road conditions to differ from the map results.

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