Provider Demographics
NPI:1306235775
Name:BAVOUSETT'S CARING KEEPERS
Entity type:Organization
Organization Name:BAVOUSETT'S CARING KEEPERS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/ DIRECTOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:WALTERINE
Authorized Official - Middle Name:M
Authorized Official - Last Name:BAVOUSETT
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:817-556-2760
Mailing Address - Street 1:405 N. RIDGEWAY DR.
Mailing Address - Street 2:SUITE 1-A
Mailing Address - City:CLEBURNE
Mailing Address - State:TX
Mailing Address - Zip Code:76033
Mailing Address - Country:US
Mailing Address - Phone:817-556-2760
Mailing Address - Fax:817-556-2760
Practice Address - Street 1:405 N. RIDGEWAY DR.
Practice Address - Street 2:SUITE 1-A
Practice Address - City:CLEBURNE
Practice Address - State:TX
Practice Address - Zip Code:76033
Practice Address - Country:US
Practice Address - Phone:817-556-2760
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-01-22
Last Update Date:2015-01-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX619604163W00000X
TXNA08704955376K00000X
TX253Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes253Z00000XAgenciesIn Home Supportive CareGroup - Multi-Specialty
No163W00000XNursing Service ProvidersRegistered NurseGroup - Multi-Specialty
No376K00000XNursing Service Related ProvidersNurse's AideGroup - Multi-Specialty