Provider Demographics
NPI:1437739265
Name:BLUEBONNET ACCESSIBILITY LLC
Entity Type:Organization
Organization Name:BLUEBONNET ACCESSIBILITY LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:VICE PRESIDENT
Authorized Official - Prefix:MS
Authorized Official - First Name:STACI
Authorized Official - Middle Name:
Authorized Official - Last Name:GONZALES
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:102-954-0268
Mailing Address - Street 1:16163 OLD STABLE RD
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78247-4490
Mailing Address - Country:US
Mailing Address - Phone:210-954-0268
Mailing Address - Fax:714-209-4024
Practice Address - Street 1:16163 OLD STABLE RD
Practice Address - Street 2:
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78247-4490
Practice Address - Country:US
Practice Address - Phone:210-954-0268
Practice Address - Fax:714-209-4024
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-04-14
Last Update Date:2023-06-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes171WH0202XOther Service ProvidersContractorHome ModificationsGroup - Single Specialty
No171WV0202XOther Service ProvidersContractorVehicle ModificationsGroup - Single Specialty