# BEACH BAY AND TACKLE LLC DBA HOME CARE PROVIDER SERVICE

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- **Entity:** Organization
- **Status:** Active
- **Other names:** Home Care Provider Service
- **Organization subpart:** No

## Provider details

- **NPI number:** 1992197412
- **Authorized official:** MICHAEL RYAN ZUMWALT LVN (OWNER)
- **Authorized official phone:** (409) 782-0332

## Contact information

- **Practice address:** 3780 MARTIN LUTHER KING JR DR, PORT ARTHUR, TX 77640-6862
- **Practice address phone:** (409) 782-0332
- **Practice address fax:** (409) 300-4389
- **Mailing address:** 3780 MARTIN LUTHER KING JR DR, PORT ARTHUR, TX 77640-6862
- **Mailing address phone:** (409) 782-0332
- **Mailing address fax:** (409) 300-4389

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 253Z00000X | In Home Supportive Care Agency | 149211 | TX | Yes |

## Other

- **Enumeration date:** 02/20/2015
- **Last updated:** 02/20/2015