Provider Demographics
NPI:1548845183
Name:ASSISTACARE LLC
Entity type:Organization
Organization Name:ASSISTACARE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER / ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:BRIE
Authorized Official - Middle Name:
Authorized Official - Last Name:STOCKWELL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:512-522-3865
Mailing Address - Street 1:19200 WHITE HORSE CV
Mailing Address - Street 2:
Mailing Address - City:SPICEWOOD
Mailing Address - State:TX
Mailing Address - Zip Code:78669-6880
Mailing Address - Country:US
Mailing Address - Phone:512-522-3865
Mailing Address - Fax:
Practice Address - Street 1:19200 WHITE HORSE CV
Practice Address - Street 2:
Practice Address - City:SPICEWOOD
Practice Address - State:TX
Practice Address - Zip Code:78669-6880
Practice Address - Country:US
Practice Address - Phone:512-522-3865
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-03-15
Last Update Date:2021-03-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253Z00000XAgenciesIn Home Supportive Care