1477003705 NPI number — MEADOWS HOME CARE LLC

Table of content: MR. BRIAN JULIAN BOMAR BSW, LLBSW (NPI 1164774840)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1477003705 NPI number — MEADOWS HOME CARE LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
MEADOWS HOME CARE LLC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1477003705
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
10/11/2016
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
114 CAROL DR
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
HUTTO
Provider Business Mailing Address State Name:
TX
Provider Business Mailing Address Postal Code:
78634-4484
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
318-791-2878
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
5300 N BRAESWOOD BLVD
Provider Second Line Business Practice Location Address:
SUITE 4-426
Provider Business Practice Location Address City Name:
HOUSTON
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
77096-3307
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
318-791-2878
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
10/11/2016

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
MEADOWS
Authorized Official First Name:
BARBARA
Authorized Official Middle Name:
ANN
Authorized Official Title or Position:
OWNER
Authorized Official Telephone Number:
318-791-2878

Provider Taxonomy Codes

  • Taxonomy code: 253Z00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)