Provider Demographics
NPI:1295061174
Name:BOUNTIFUL LIVING RESIDENTIAL CARE INC
Entity type:Organization
Organization Name:BOUNTIFUL LIVING RESIDENTIAL CARE INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MS
Authorized Official - First Name:LIZA
Authorized Official - Middle Name:AVA
Authorized Official - Last Name:FOSTER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:281-250-7207
Mailing Address - Street 1:7010 DESERT BLUFF LN
Mailing Address - Street 2:
Mailing Address - City:RICHMOND
Mailing Address - State:TX
Mailing Address - Zip Code:77407-3824
Mailing Address - Country:US
Mailing Address - Phone:281-250-7207
Mailing Address - Fax:281-232-2169
Practice Address - Street 1:7010 DESERT BLUFF LN
Practice Address - Street 2:
Practice Address - City:RICHMOND
Practice Address - State:TX
Practice Address - Zip Code:77407-3824
Practice Address - Country:US
Practice Address - Phone:281-250-7207
Practice Address - Fax:281-232-2169
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-10-27
Last Update Date:2019-07-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes320900000XResidential Treatment FacilitiesCommunity Based Residential Treatment Facility, Intellectual and/or Developmental DisabilitiesGroup - Single Specialty
No171M00000XOther Service ProvidersCase Manager/Care CoordinatorGroup - Single Specialty