Provider Demographics
NPI:1043687908
Name:BOLAD HEALTH CARE SERVICES LLC
Entity Type:Organization
Organization Name:BOLAD HEALTH CARE SERVICES LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR /OWNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:OLUBUNMI
Authorized Official - Middle Name:ADEBOLA
Authorized Official - Last Name:OKETUNMBI
Authorized Official - Suffix:
Authorized Official - Credentials:RN
Authorized Official - Phone:719-406-9160
Mailing Address - Street 1:13828 SUTHERLAND SPRING LN
Mailing Address - Street 2:
Mailing Address - City:ROSHARON
Mailing Address - State:TX
Mailing Address - Zip Code:77583
Mailing Address - Country:US
Mailing Address - Phone:346-715-6084
Mailing Address - Fax:281-595-7668
Practice Address - Street 1:13828 SUTHERLAND SPRING LN
Practice Address - Street 2:
Practice Address - City:ROSHARON
Practice Address - State:TX
Practice Address - Zip Code:77583-2149
Practice Address - Country:US
Practice Address - Phone:719-406-9160
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-08-27
Last Update Date:2018-06-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX018630251E00000X, 251G00000X
TX253Z00000X, 385HR2060X
3104A0625X, 3104A0630X, 311ZA0620X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
No251G00000XAgenciesHospice Care, Community Based
No253Z00000XAgenciesIn Home Supportive Care
No3104A0625XNursing & Custodial Care FacilitiesAssisted Living FacilityAssisted Living, Mental Illness
No3104A0630XNursing & Custodial Care FacilitiesAssisted Living FacilityAssisted Living, Behavioral Disturbances
No311ZA0620XNursing & Custodial Care FacilitiesCustodial Care FacilityAdult Care Home
No385HR2060XRespite Care FacilityRespite CareRespite Care, Intellectual and/or Developmental Disabilities, Child