Provider Demographics
NPI:1790293694
Name:BRANCHING OUT CUSTOM CARE
Entity Type:Organization
Organization Name:BRANCHING OUT CUSTOM CARE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:ROBIN
Authorized Official - Middle Name:LYNNETTE
Authorized Official - Last Name:BAYER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:817-312-7041
Mailing Address - Street 1:5047 KNIGHT LN
Mailing Address - Street 2:
Mailing Address - City:KRUM
Mailing Address - State:TX
Mailing Address - Zip Code:76249-7100
Mailing Address - Country:US
Mailing Address - Phone:817-312-7041
Mailing Address - Fax:
Practice Address - Street 1:5047 KNIGHT LN
Practice Address - Street 2:
Practice Address - City:KRUM
Practice Address - State:TX
Practice Address - Zip Code:76249-7100
Practice Address - Country:US
Practice Address - Phone:817-312-7041
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-01-14
Last Update Date:2018-01-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251B00000XAgenciesCase Management