Provider Demographics
NPI:1467905414
Name:HOMECARE VERIZONS
Entity Type:Organization
Organization Name:HOMECARE VERIZONS
Other - Org Name:DAVID BONIFACE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:
Authorized Official - Last Name:BONIFACE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:281-338-9829
Mailing Address - Street 1:206 MEADOW GATE DR
Mailing Address - Street 2:
Mailing Address - City:LEAGUE CITY
Mailing Address - State:TX
Mailing Address - Zip Code:77573-0850
Mailing Address - Country:US
Mailing Address - Phone:281-338-9829
Mailing Address - Fax:281-338-9830
Practice Address - Street 1:206 MEADOW GATE DR
Practice Address - Street 2:
Practice Address - City:LEAGUE CITY
Practice Address - State:TX
Practice Address - Zip Code:77573-0850
Practice Address - Country:US
Practice Address - Phone:281-338-9829
Practice Address - Fax:281-338-9830
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-07-26
Last Update Date:2016-07-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX016327251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health