Provider Demographics
NPI:1821480542
Name:LBJ HEALTHCARE PARTNERS, INC
Entity Type:Organization
Organization Name:LBJ HEALTHCARE PARTNERS, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:BRIAN
Authorized Official - Middle Name:
Authorized Official - Last Name:BUENVIAJE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:562-941-3813
Mailing Address - Street 1:13749 CREWE ST
Mailing Address - Street 2:
Mailing Address - City:WHITTIER
Mailing Address - State:CA
Mailing Address - Zip Code:90605-4008
Mailing Address - Country:US
Mailing Address - Phone:562-941-3813
Mailing Address - Fax:562-941-0589
Practice Address - Street 1:13749 CREWE ST
Practice Address - Street 2:
Practice Address - City:WHITTIER
Practice Address - State:CA
Practice Address - Zip Code:90605-4008
Practice Address - Country:US
Practice Address - Phone:562-941-3813
Practice Address - Fax:562-941-0589
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-03-04
Last Update Date:2015-03-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA306004456320700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes320700000XResidential Treatment FacilitiesResidential Treatment Facility, Physical Disabilities