Provider Demographics
NPI:1992273759
Name:BROTHER'S KEEPER IN-HOME CARE, LLC
Entity type:Organization
Organization Name:BROTHER'S KEEPER IN-HOME CARE, LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:LAWANA
Authorized Official - Middle Name:
Authorized Official - Last Name:MILJENOVICH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:512-297-4285
Mailing Address - Street 1:PO BOX 1633
Mailing Address - Street 2:
Mailing Address - City:LIBERTY HILL
Mailing Address - State:TX
Mailing Address - Zip Code:78642-1633
Mailing Address - Country:US
Mailing Address - Phone:512-297-4285
Mailing Address - Fax:512-957-2087
Practice Address - Street 1:3103 RR 1869
Practice Address - Street 2:
Practice Address - City:LIBERTY HILL
Practice Address - State:TX
Practice Address - Zip Code:78642-4288
Practice Address - Country:US
Practice Address - Phone:512-297-4285
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-11-08
Last Update Date:2019-01-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253Z00000XAgenciesIn Home Supportive Care