Organization
BEACH BAY AND TACKLE LLC DBA HOME CARE PROVIDER SERVICE
Active
Other names
Home Care Provider Service
Organization subpart
No
Provider details
NPI number
Authorized official
MICHAEL RYAN ZUMWALT LVN (OWNER)
(409) 782-0332
Entity
Organization
Contact information
Practice address
3780 MARTIN LUTHER KING JR DR, PORT ARTHUR, TX 77640-6862
(409) 782-0332
(409) 300-4389
Mailing address
3780 MARTIN LUTHER KING JR DR, PORT ARTHUR, TX 77640-6862
(409) 782-0332
(409) 300-4389
Taxonomy
Speciality
Code
Description
License number
State
253Z00000X
In Home Supportive Care Agency
Primary
149211
TX
Other
Enumeration date
02/20/2015
Last updated
02/20/2015
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