1972099604 NPI number — BLACK DOG HOME CARE, LLC

Table of content: DR. PIOTR WALDEMAR BAGINSKI MD (NPI 1164449906)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1972099604 NPI number — BLACK DOG HOME CARE, LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
BLACK DOG 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:
6
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:
1972099604
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
07/05/2018
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
8700 CROWNHILL BLVD STE 706
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
SAN ANTONIO
Provider Business Mailing Address State Name:
TX
Provider Business Mailing Address Postal Code:
78209-1132
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
210-308-9346
Provider Business Mailing Address Fax Number:
210-308-9352

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
8700 CROWNHILL BLVD STE 706
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
SAN ANTONIO
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
78209-1132
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
210-308-9346
Provider Business Practice Location Address Fax Number:
210-308-9352
Provider Enumeration Date:
07/05/2018

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
WENDELL
Authorized Official First Name:
SLOANE
Authorized Official Middle Name:
COLLEEN
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
210-308-9342

Provider Taxonomy Codes

  • Taxonomy code: 253Z00000X , with the licence number:  018533 , registered in the state of TX ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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