MEDICARE: BHAL, 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	310400000X	Assisted Living Facility	000389	TX

General Provider Information

NPI Number	:	1669984613
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	BHAL, LLC

Provider Business Mailing Address
First Line	:	1606 NASH AVE
Second Line	:
City	:	AUSTIN
State	:	TX
Zip	:	78704-3332
Country	:	US
Telephone Number	:	512-441-6000
Fax Number	:

Provider Business Practice Location Address
First Line	:	1606 NASH AVE
Second Line	:
City	:	AUSTIN
State	:	TX
Zip	:	78704-3332
Country	:	US
Telephone Number	:	512-441-6000
Fax Number	:

Authorized Official
Title or Position	:	CEO
Name	:	MR. IBRAHIM KHANMOHAMED
Credential	:
Telephone Number	:	512-441-6000

Provider Enumeration Date	:	10/31/2017
Last Update Date	:	10/31/2017

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