Provider Demographics
NPI:1104058726
Name:BMB SPECIAL CARE
Entity type:Organization
Organization Name:BMB SPECIAL CARE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MS
Authorized Official - First Name:PATRICIA
Authorized Official - Middle Name:A
Authorized Official - Last Name:BOSTIC
Authorized Official - Suffix:
Authorized Official - Credentials:HOME HEALTH AGENCY
Authorized Official - Phone:478-984-5770
Mailing Address - Street 1:1169 DEER FIELD LN
Mailing Address - Street 2:
Mailing Address - City:DUBLIN
Mailing Address - State:GA
Mailing Address - Zip Code:31021-4753
Mailing Address - Country:US
Mailing Address - Phone:478-984-5770
Mailing Address - Fax:478-984-5770
Practice Address - Street 1:1169 DEER FIELD LN
Practice Address - Street 2:
Practice Address - City:DUBLIN
Practice Address - State:GA
Practice Address - Zip Code:31021-4753
Practice Address - Country:US
Practice Address - Phone:478-984-5770
Practice Address - Fax:478-984-5770
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-08-14
Last Update Date:2009-08-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA087 - R - 0528251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health