Provider Demographics
NPI:1376879601
Name:DOMUS LIFECARE,LLC
Entity Type:Organization
Organization Name:DOMUS LIFECARE,LLC
Other - Org Name:BRIGHTSTAR
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER/MANAGING PARTNER
Authorized Official - Prefix:MR
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:DAVID
Authorized Official - Last Name:STEVENSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:210-337-3355
Mailing Address - Street 1:7400 BLANCO RD
Mailing Address - Street 2:SUITE 111
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78216-4360
Mailing Address - Country:US
Mailing Address - Phone:210-337-3355
Mailing Address - Fax:210-337-3356
Practice Address - Street 1:7400 BLANCO RD
Practice Address - Street 2:SUITE 111
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78216-4360
Practice Address - Country:US
Practice Address - Phone:210-337-3355
Practice Address - Fax:210-337-3356
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-10-21
Last Update Date:2012-04-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251J00000XAgenciesNursing Care
No253Z00000XAgenciesIn Home Supportive Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX2833709Medicaid