MEDICARE: SHEILA BOMA

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	385HR2060X	Child Intellectual and/or Developmental Disabilities Respite Care

General Provider Information

NPI Number	:	1851591093
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SHEILA BOMA

Provider Business Mailing Address
First Line	:	1601 COURTNEY LANE
Second Line	:
City	:	CEDAR PARK
State	:	TX
Zip	:	78613
Country	:	US
Telephone Number	:	512-436-4876
Fax Number	:

Provider Business Practice Location Address
First Line	:	1601 COURTNEY LN
Second Line	:
City	:	CEDAR PARK
State	:	TX
Zip	:	78613-3575
Country	:	US
Telephone Number	:	512-436-4876
Fax Number	:

Authorized Official
Title or Position	:	ADMINISTRATOR
Name	:	MRS. SHEILA BOMA
Credential	:	ADMINISTRATOR
Telephone Number	:	512-436-4877

Provider Enumeration Date	:	07/24/2007
Last Update Date	:	07/24/2007

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