Provider Demographics
NPI:1083892442
Name:BROADMOOR HEALTHCARE HOLDINGS, LLC
Entity Type:Organization
Organization Name:BROADMOOR HEALTHCARE HOLDINGS, LLC
Other - Org Name:BRIGHTSTAR HEALTHCARE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:GEORGE
Authorized Official - Middle Name:
Authorized Official - Last Name:SANCHEZ
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:512-452-9800
Mailing Address - Street 1:1317 PICADILLY DR STE B201
Mailing Address - Street 2:
Mailing Address - City:PFLUGERVILLE
Mailing Address - State:TX
Mailing Address - Zip Code:78660-1891
Mailing Address - Country:US
Mailing Address - Phone:512-452-9800
Mailing Address - Fax:512-452-9801
Practice Address - Street 1:1317 PICADILLY DR STE B201
Practice Address - Street 2:
Practice Address - City:PFLUGERVILLE
Practice Address - State:TX
Practice Address - Zip Code:78660-1891
Practice Address - Country:US
Practice Address - Phone:512-452-9800
Practice Address - Fax:512-452-9801
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-02-07
Last Update Date:2021-03-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX015640251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX015640OtherTEXAS DADS
TX3247462-01Medicaid