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NPI Code Detail

MEDICARE: BRENHAM HC HOLDINGS LLC

MEDICARE: BRENHAM HC HOLDINGS LLC
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
1313M00000XNursing Facility/Intermediate Care Facility
2314000000XSkilled Nursing Facility134683TX

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1336405588
Entity Type Code : Organization
Provider Name (Legal Business Name) : BRENHAM HC HOLDINGS LLC
Provider Business Mailing Address
First Line : 127 W BROAD ST
Second Line : SUITE 800
City : LAKE CHARLES
State : LA
Zip : 70601-4291
Country : US
Telephone Number : 337-439-6600
Fax Number : 337-439-6647
Provider Business Practice Location Address
First Line : 401 E BLUE BELL RD
Second Line :
City : BRENHAM
State : TX
Zip : 77833-2407
Country : US
Telephone Number : 979-836-6611
Fax Number :
Authorized Official
Title or Position : MANAGING MEMBER
Name : KENDALL A BROUSSARD
Credential :
Telephone Number : 337-439-6600
Provider Enumeration Date : 04/02/2012
Last Update Date : 11/16/2012

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Directions to “BRENHAM HC HOLDINGS LLC ” Practice Location

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