Provider Demographics
NPI:1528600897
Name:BLUEBONNET PRIMARY HOME CARE LLC
Entity Type:Organization
Organization Name:BLUEBONNET PRIMARY HOME CARE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:VANESSA
Authorized Official - Middle Name:
Authorized Official - Last Name:TREVINO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:956-589-5026
Mailing Address - Street 1:1575 MILITARY HWY 281 STE 106
Mailing Address - Street 2:
Mailing Address - City:BROWNSVILLE
Mailing Address - State:TX
Mailing Address - Zip Code:78520-3408
Mailing Address - Country:US
Mailing Address - Phone:956-517-6260
Mailing Address - Fax:956-372-1128
Practice Address - Street 1:1575 MILITARY HWY 281 STE 106
Practice Address - Street 2:
Practice Address - City:BROWNSVILLE
Practice Address - State:TX
Practice Address - Zip Code:78520-3408
Practice Address - Country:US
Practice Address - Phone:956-517-6260
Practice Address - Fax:956-372-1128
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-10-08
Last Update Date:2023-08-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes3747P1801XNursing Service Related ProvidersTechnicianPersonal Care AttendantGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX1306499579Medicaid