Provider Demographics
NPI:1689968364
Name:KINGSMEN VENTURES, LLC
Entity Type:Organization
Organization Name:KINGSMEN VENTURES, LLC
Other - Org Name:BRIDGES HOME HEALTHCARE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:ALAN
Authorized Official - Last Name:LESLIE
Authorized Official - Suffix:
Authorized Official - Credentials:RN, MBA
Authorized Official - Phone:832-349-6678
Mailing Address - Street 1:21406 E GOLD BUTTERCUP CT
Mailing Address - Street 2:
Mailing Address - City:CYPRESS
Mailing Address - State:TX
Mailing Address - Zip Code:77433-3510
Mailing Address - Country:US
Mailing Address - Phone:832-349-6678
Mailing Address - Fax:
Practice Address - Street 1:21406 E GOLD BUTTERCUP CT
Practice Address - Street 2:
Practice Address - City:CYPRESS
Practice Address - State:TX
Practice Address - Zip Code:77433-3510
Practice Address - Country:US
Practice Address - Phone:832-349-6678
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-05-31
Last Update Date:2011-07-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health