Provider Demographics
NPI:1982860417
Name:NATIONAL SENIOR CARE
Entity Type:Organization
Organization Name:NATIONAL SENIOR CARE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/VP OF NURSING
Authorized Official - Prefix:
Authorized Official - First Name:MARC
Authorized Official - Middle Name:
Authorized Official - Last Name:BOBO
Authorized Official - Suffix:
Authorized Official - Credentials:RN, BSN
Authorized Official - Phone:903-553-0004
Mailing Address - Street 1:905 N. 4TH STREET
Mailing Address - Street 2:
Mailing Address - City:LONGVIEW
Mailing Address - State:TX
Mailing Address - Zip Code:75601
Mailing Address - Country:US
Mailing Address - Phone:903-553-0004
Mailing Address - Fax:866-236-4022
Practice Address - Street 1:6150 RICHMOND AVE
Practice Address - Street 2:STE 214
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77057
Practice Address - Country:US
Practice Address - Phone:713-780-2390
Practice Address - Fax:888-420-4606
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-08-04
Last Update Date:2013-09-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX010139251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX679786Medicare PIN