Provider Demographics
NPI:1881051852
Name:RONICA HOME CARE LLC
Entity type:Organization
Organization Name:RONICA HOME CARE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:BETRAND
Authorized Official - Middle Name:C
Authorized Official - Last Name:EZEMA EZEMA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:512-579-9698
Mailing Address - Street 1:2800 LA FRONTERA BLVD APT 3018
Mailing Address - Street 2:2800 LA FRONTERA BLVD # 3018
Mailing Address - City:ROUND ROCK
Mailing Address - State:TX
Mailing Address - Zip Code:78681-7958
Mailing Address - Country:US
Mailing Address - Phone:512-579-9698
Mailing Address - Fax:512-294-2847
Practice Address - Street 1:2800 LA FRONTERA BLVD APT 3018
Practice Address - Street 2:2800 LA FRONTERA BLVD # 3018
Practice Address - City:ROUND ROCK
Practice Address - State:TX
Practice Address - Zip Code:78681-7958
Practice Address - Country:US
Practice Address - Phone:512-579-9698
Practice Address - Fax:512-294-2847
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-01-21
Last Update Date:2016-01-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX650576540002311ZA0620X, 320800000X, 320900000X, 3104A0625X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3104A0625XNursing & Custodial Care FacilitiesAssisted Living FacilityAssisted Living, Mental Illness
No311ZA0620XNursing & Custodial Care FacilitiesCustodial Care FacilityAdult Care Home
No320800000XResidential Treatment FacilitiesCommunity Based Residential Treatment Facility, Mental Illness
No320900000XResidential Treatment FacilitiesCommunity Based Residential Treatment Facility, Intellectual and/or Developmental Disabilities