Provider Demographics
NPI:1134411366
Name:BABYBOOMERS HOMECARE LLC
Entity type:Organization
Organization Name:BABYBOOMERS HOMECARE LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MR
Authorized Official - First Name:MOHAMMAD
Authorized Official - Middle Name:A
Authorized Official - Last Name:SUBEDAR
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:713-876-3872
Mailing Address - Street 1:1711 JAMES BOWIE DR APT 504
Mailing Address - Street 2:
Mailing Address - City:BAYTOWN
Mailing Address - State:TX
Mailing Address - Zip Code:77520-3309
Mailing Address - Country:US
Mailing Address - Phone:713-876-3872
Mailing Address - Fax:
Practice Address - Street 1:630 COLONY LAKE ESTATES DR APT 428
Practice Address - Street 2:
Practice Address - City:STAFFORD
Practice Address - State:TX
Practice Address - Zip Code:77477-4667
Practice Address - Country:US
Practice Address - Phone:713-876-3872
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-05-05
Last Update Date:2011-05-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253Z00000XAgenciesIn Home Supportive Care