Provider Demographics
NPI:1982446548
Name:BLUEBONNET HAVEN, LLC
Entity type:Organization
Organization Name:BLUEBONNET HAVEN, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/EXECUTIVE DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:RACHEL
Authorized Official - Middle Name:
Authorized Official - Last Name:BLANKENBURG
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:979-421-0736
Mailing Address - Street 1:4150 HIGHWAY 36 S
Mailing Address - Street 2:
Mailing Address - City:BRENHAM
Mailing Address - State:TX
Mailing Address - Zip Code:77833-8164
Mailing Address - Country:US
Mailing Address - Phone:979-347-6662
Mailing Address - Fax:
Practice Address - Street 1:4150 HIGHWAY 36 S
Practice Address - Street 2:
Practice Address - City:BRENHAM
Practice Address - State:TX
Practice Address - Zip Code:77833-8164
Practice Address - Country:US
Practice Address - Phone:979-347-6662
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-06-12
Last Update Date:2024-06-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes322D00000XResidential Treatment FacilitiesResidential Treatment Facility, Emotionally Disturbed Children
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Multi-Specialty
No101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Multi-Specialty
No320600000XResidential Treatment FacilitiesResidential Treatment Facility, Intellectual and/or Developmental Disabilities