Provider Demographics
NPI:1780913178
Name:BLUEBONNET ASSISTED LIVING, LLC
Entity type:Organization
Organization Name:BLUEBONNET ASSISTED LIVING, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:MS
Authorized Official - First Name:JENNIFER
Authorized Official - Middle Name:
Authorized Official - Last Name:WOMACK
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:806-676-7638
Mailing Address - Street 1:6301 BLAKE AVE
Mailing Address - Street 2:
Mailing Address - City:AMARILLO
Mailing Address - State:TX
Mailing Address - Zip Code:79119-7201
Mailing Address - Country:US
Mailing Address - Phone:806-351-0686
Mailing Address - Fax:806-467-1359
Practice Address - Street 1:6301 BLAKE AVE
Practice Address - Street 2:
Practice Address - City:AMARILLO
Practice Address - State:TX
Practice Address - Zip Code:79119-7201
Practice Address - Country:US
Practice Address - Phone:806-351-0686
Practice Address - Fax:806-467-1359
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-12-14
Last Update Date:2009-12-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility