Provider Demographics
NPI:1316346893
Name:BC COLLINS HOME
Entity type:Organization
Organization Name:BC COLLINS HOME
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PROGRAM MANAGER
Authorized Official - Prefix:MR
Authorized Official - First Name:ISAAC
Authorized Official - Middle Name:
Authorized Official - Last Name:TUBONEMI
Authorized Official - Suffix:SR
Authorized Official - Credentials:
Authorized Official - Phone:512-785-7795
Mailing Address - Street 1:2612 BYFIELD DR
Mailing Address - Street 2:
Mailing Address - City:CEDAR PARK
Mailing Address - State:TX
Mailing Address - Zip Code:78613-7614
Mailing Address - Country:US
Mailing Address - Phone:512-785-7795
Mailing Address - Fax:
Practice Address - Street 1:2612 BYFIELD DR
Practice Address - Street 2:
Practice Address - City:CEDAR PARK
Practice Address - State:TX
Practice Address - Zip Code:78613-7614
Practice Address - Country:US
Practice Address - Phone:512-785-7795
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-08-20
Last Update Date:2014-08-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes311ZA0620XNursing & Custodial Care FacilitiesCustodial Care FacilityAdult Care Home