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Organization

BLUE LINE COMMUNITY SERVICES LLC

Active
Organization subpart
No

Provider details

NPI number
Authorized official
KEVIN MICHAEL KRZAN (MANAGING MEMBER)
(512) 800-0013
Entity
Organization

Contact information

Practice address
1002 TOLTEC TRL, GEORGETOWN, TX 78626-7053
(512) 800-0013
Mailing address
1002 TOLTEC TRL, GEORGETOWN, TX 78626-7053
(512) 800-0013

Taxonomy

Speciality
Code
Description
License number
State
253J00000X
Foster Care Agency
Primary
320900000X
Intellectual and/or Developmental Disabilities Community Based Residential Treatment Facility

Other

Enumeration date
02/08/2023
Last updated
02/08/2023
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