1841462009 NPI number — BMR-1 VA, LLC

Table of content: (NPI 1841462009)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1841462009 NPI number — BMR-1 VA, LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
BMR-1 VA, 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:
AMERICAN SENIOR CARE
Provider Other Organization Name Type Code:
3
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:
1841462009
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/16/2012
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
905 N 4TH ST
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
LONGVIEW
Provider Business Mailing Address State Name:
TX
Provider Business Mailing Address Postal Code:
75601
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
903-746-4327
Provider Business Mailing Address Fax Number:
866-642-5260

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
420 N CENTER DR STE #145
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
NORFOLK
Provider Business Practice Location Address State Name:
VA
Provider Business Practice Location Address Postal Code:
23502
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
866-642-7960
Provider Business Practice Location Address Fax Number:
866-642-5260
Provider Enumeration Date:
03/27/2008

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
MCARDLE
Authorized Official First Name:
BILL
Authorized Official Middle Name:
LLOYD
Authorized Official Title or Position:
OWNER
Authorized Official Telephone Number:
903-746-4327

Provider Taxonomy Codes

  • Taxonomy code: 251E00000X , with the licence number:  TBA , registered in the state of VA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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