MEDICARE: BLUEBONNET ASSISTED LIVING, 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
1	3104A0625X	Assisted Living Facility (Mental Illness)

General Provider Information

NPI Number	:	1477404671
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	BLUEBONNET ASSISTED LIVING, LLC

Provider Business Mailing Address
First Line	:	19611 ALBANY OAKS LN
Second Line	:
City	:	RICHMOND
State	:	TX
Zip	:	77407-2352
Country	:	US
Telephone Number	:	832-451-8315
Fax Number	:	832-451-6424

Provider Business Practice Location Address
First Line	:	19611 ALBANY OAKS LN
Second Line	:
City	:	RICHMOND
State	:	TX
Zip	:	77407-2352
Country	:	US
Telephone Number	:	832-451-8315
Fax Number	:	832-451-6424

Authorized Official
Title or Position	:	MANAGER
Name	:	AIDA GARCIA
Credential	:
Telephone Number	:	832-451-8315

Provider Enumeration Date	:	02/04/2026
Last Update Date	:	02/04/2026

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