Provider Demographics
NPI:1619550621
Name:BALICARE HEALTH PLLC
Entity Type:Organization
Organization Name:BALICARE HEALTH PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MS
Authorized Official - First Name:VICTORINE
Authorized Official - Middle Name:
Authorized Official - Last Name:YANGNI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:832-228-4057
Mailing Address - Street 1:4002 LAKE BRAZOS LN
Mailing Address - Street 2:
Mailing Address - City:RICHMOND
Mailing Address - State:TX
Mailing Address - Zip Code:77406-8093
Mailing Address - Country:US
Mailing Address - Phone:832-228-4057
Mailing Address - Fax:
Practice Address - Street 1:4002 LAKE BRAZOS LN
Practice Address - Street 2:
Practice Address - City:RICHMOND
Practice Address - State:TX
Practice Address - Zip Code:77406-8093
Practice Address - Country:US
Practice Address - Phone:832-228-4057
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-04-28
Last Update Date:2021-04-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamilyGroup - Multi-Specialty