NPI: 1114469046 · BRIDGEPORT, TX 76426 · Assisted Living Facility · NPI assigned 11/09/2016
| Authorized Official | BOULWARE, DOUGLAS (MANAGING MEMBER) |
| NPI Enumeration Date | 11/09/2016 |
| Year | Claims | Total Paid |
|---|---|---|
| 2021 | 155 | $144K |
| 2022 | 128 | $153K |
| Code | Description | Claims | Beneficiaries | Total Paid |
|---|---|---|---|---|
| T2031 | Assisted living; waiver, per diem | 283 | 250 | $296K |