Provider Demographics
NPI:1457739146
Name:BUCKNER RETIREMENT SERVICES, INC.
Entity Type:Organization
Organization Name:BUCKNER RETIREMENT SERVICES, INC.
Other - Org Name:BUCKNER AT HOME - HOUSTON
Other - Org Type:Doing Business As
Authorized Official - Title/Position:SENIOR VICE PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:CHARLIE
Authorized Official - Middle Name:G
Authorized Official - Last Name:WILSON
Authorized Official - Suffix:
Authorized Official - Credentials:LNFA
Authorized Official - Phone:214-758-8031
Mailing Address - Street 1:11111 KATY FREEWAY
Mailing Address - Street 2:SUITE 520
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77079-2116
Mailing Address - Country:US
Mailing Address - Phone:281-493-6800
Mailing Address - Fax:821-493-6807
Practice Address - Street 1:11111 KATY FREEWAY
Practice Address - Street 2:SUITE 520
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77079-2116
Practice Address - Country:US
Practice Address - Phone:281-493-6800
Practice Address - Fax:821-493-6807
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:BUCKNER RETIREMENT SERVICES, INC.
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2015-05-13
Last Update Date:2015-05-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes3747P1801XNursing Service Related ProvidersTechnicianPersonal Care AttendantGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX1019436Medicaid
TX671661Medicare PIN