Provider Demographics
NPI:1366563157
Name:BLUEBONNET RESIDENTIAL CENTER - GENERAL PARTNERSHIP
Entity type:Organization
Organization Name:BLUEBONNET RESIDENTIAL CENTER - GENERAL PARTNERSHIP
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:FINANCIAL ADMINISTRATOR
Authorized Official - Prefix:MR
Authorized Official - First Name:STEPHEN
Authorized Official - Middle Name:JOEL
Authorized Official - Last Name:ZAGER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:817-389-3442
Mailing Address - Street 1:524 N PEARSON ST
Mailing Address - Street 2:
Mailing Address - City:GODLEY
Mailing Address - State:TX
Mailing Address - Zip Code:76044-3702
Mailing Address - Country:US
Mailing Address - Phone:817-389-3442
Mailing Address - Fax:817-389-2354
Practice Address - Street 1:524 N PEARSON ST
Practice Address - Street 2:
Practice Address - City:GODLEY
Practice Address - State:TX
Practice Address - Zip Code:76044-3702
Practice Address - Country:US
Practice Address - Phone:817-389-3442
Practice Address - Fax:817-389-2354
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-02
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX115074315P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes315P00000XNursing & Custodial Care FacilitiesIntermediate Care Facility, Intellectual Disabilities