Provider Demographics
NPI:1427403898
Name:DMBW PERSONAL CARE HOME, INC
Entity Type:Organization
Organization Name:DMBW PERSONAL CARE HOME, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MS
Authorized Official - First Name:MARINA
Authorized Official - Middle Name:LISA
Authorized Official - Last Name:MONTEZ-BAUGH
Authorized Official - Suffix:
Authorized Official - Credentials:MS
Authorized Official - Phone:210-748-4811
Mailing Address - Street 1:8607 WURZBACH RD BLD V ROOM 201 C
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78240-1303
Mailing Address - Country:US
Mailing Address - Phone:210-262-5675
Mailing Address - Fax:210-699-9282
Practice Address - Street 1:7126 CORAL SPGS
Practice Address - Street 2:
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78250-6232
Practice Address - Country:US
Practice Address - Phone:210-262-5675
Practice Address - Fax:210-699-9282
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-05-04
Last Update Date:2016-05-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX324112253Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253Z00000XAgenciesIn Home Supportive Care