Charleston Boerne Operations, LLC

Primary specialty

Skilled Nursing FacilityTaxonomy code 314000000X

License

135182 Issued in TX

Legal business name

CHARLESTON BOERNE OPERATIONS, LLC

Practice address

200 Ryan St
Boerne, TX 78006-2046

Phone

(830) 249-2594

Fax

(830) 248-1314

NPI assigned

May 8, 2014

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Kendall A Broussard

Title

Managing Member

Phone

(337) 439-6600

Specialties & licenses 1

Addresses

Other names 1

• Carechoice of Boerne Doing business as

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1399507200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1399593600000",
    "number": "1295146546",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "200 RYAN ST",
            "city": "BOERNE",
            "state": "TX",
            "postal_code": "780062046",
            "telephone_number": "830-249-2594",
            "fax_number": "830-248-1314"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "200 RYAN ST",
            "city": "BOERNE",
            "state": "TX",
            "postal_code": "780062046",
            "telephone_number": "830-249-2594",
            "fax_number": "830-248-1314"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "CHARLESTON BOERNE OPERATIONS, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2014-05-08",
        "last_updated": "2014-05-09",
        "status": "A",
        "authorized_official_last_name": "BROUSSARD",
        "authorized_official_first_name": "KENDALL",
        "authorized_official_middle_name": "A",
        "authorized_official_title_or_position": "MANAGING MEMBER",
        "authorized_official_telephone_number": "337-439-6600"
    },
    "taxonomies": [
        {
            "code": "314000000X",
            "taxonomy_group": "",
            "desc": "Skilled Nursing Facility",
            "state": "TX",
            "license": "135182",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Carechoice of Boerne",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Jacqlyn Cervantes
• Laura Cervantes, LVN
• Alexandra Chaheine, PA-C
• Don Chamberlain, AU.D.
• Teagan Nichole Charles, MPAS, PA-C
• Crystal Haydee Chavez, M.D.
• Lauren Alexandria Chavez
• Richard L Childers, DPM
• Cibolo Counseling and Life Coaching
• Cibolo Creek Allergy PA

• Skilled Nursing Facility in Boerne, TX
• Providers in Boerne, TX by specialty
• Skilled Nursing Facility in Texas

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 9, 2014; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.