Provider Demographics
NPI:1194755991
Name:BOLTON HEALTH CARE L.L.C.
Entity type:Organization
Organization Name:BOLTON HEALTH CARE L.L.C.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:RENEE
Authorized Official - Middle Name:E
Authorized Official - Last Name:ALLEN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:409-927-4703
Mailing Address - Street 1:13246 HIGHWAY 6
Mailing Address - Street 2:
Mailing Address - City:SANTA FE
Mailing Address - State:TX
Mailing Address - Zip Code:77510-7682
Mailing Address - Country:US
Mailing Address - Phone:409-927-4703
Mailing Address - Fax:409-927-4738
Practice Address - Street 1:13246 HIGHWAY 6
Practice Address - Street 2:
Practice Address - City:SANTA FE
Practice Address - State:TX
Practice Address - Zip Code:77510-7682
Practice Address - Country:US
Practice Address - Phone:409-927-4703
Practice Address - Fax:409-927-4738
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-04
Last Update Date:2013-01-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX010147251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX6093520001Medicare NSC
TX677977Medicare Oscar/Certification