Provider Demographics
NPI:1619994514
Name:BLUEBONNET HOME HEALTH CARE OF TEXAS, INC.
Entity Type:Organization
Organization Name:BLUEBONNET HOME HEALTH CARE OF TEXAS, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR OF OPERATIONS
Authorized Official - Prefix:
Authorized Official - First Name:MICHELLE
Authorized Official - Middle Name:
Authorized Official - Last Name:PETERSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:512-303-3912
Mailing Address - Street 1:125 HARMON RD
Mailing Address - Street 2:
Mailing Address - City:BASTROP
Mailing Address - State:TX
Mailing Address - Zip Code:78602-5698
Mailing Address - Country:US
Mailing Address - Phone:512-303-3912
Mailing Address - Fax:512-303-0323
Practice Address - Street 1:125 HARMON RD
Practice Address - Street 2:
Practice Address - City:BASTROP
Practice Address - State:TX
Practice Address - Zip Code:78602-5698
Practice Address - Country:US
Practice Address - Phone:512-303-3912
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-16
Last Update Date:2020-08-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX001002345OtherMDCP
TX019184OtherHHSC
TX000077300OtherPHC
TX000643900OtherCBA