NPIMap

Organization Active NPI

Waco Bluebonnet Holdings, Inc.

Doing business as Bluebonnet Health Services of Waco

  • Home Health Agency
  • Waco, TX
National Provider Identifier
1629136742
Registry record updated Aug 23, 2017
On this page

Key facts

NPPES NPI Registry
Primary specialty
Home Health AgencyTaxonomy code 251E00000X
License
008977 Issued in TX
Legal business name
WACO BLUEBONNET HOLDINGS, INC.
Doing business as
Bluebonnet Health Services of Waco
Practice address
2020 N Valley Mills
Waco, TX 76710-2561
Phone
(254) 772-5577
Fax
(254) 772-5588
NPI assigned
Dec 4, 2006
Last updated
Aug 23, 2017By the provider in NPPES
Organization subpart
Yes
Parent organization
AMC HEALTHCARE HOLDINGS, INCAs reported in NPPES

NPPES NPI Registry

Updated by the provider on Aug 23, 2017

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

Authorized official

Name
Brent McKenzie
Title
Ceo
Phone
(254) 772-5577

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Home Health Agency 251E00000X 008977 TX Primary

Addresses

Primary practice location

2020 N Valley Mills
Waco, TX 76710-2561

Mailing address

2020 N. Valley Mills Dr
Waco, TX 76710

Other identifiers 1

IdentifierTypeStateIssuer
173233101MedicaidTX

Other names 1

  • Bluebonnet Health Services of Waco Doing business as

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in TX

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20110131000277 TX Part A Provider - Home Health Agency 1153447909 Practice locations: Waco, TX

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1629136742. Details of each certification follow.

Home health agency certification: CCN 453141

Legal name
WACO BLUEBONNET HOLDINGS, INC.
Doing business as
BLUEBONNET HEALTH SERVICES OF WACO
Certification status
Active
Provider type (POS)
Home health agency
Participating since
Aug 19, 2004
Last certification
Jan 26, 2021
Ownership / control type
Proprietary
Organization structure
CorporationProprietary
Incorporated
Apr 28, 2010 in TX
Enrollment address
720 N 64TH St
Waco, TX 76710-4387

Other NPIs with the same Medicare PAC ID 2

NPIs whose Medicare enrollments share a PECOS associate control ID (the same enrolled entity).

Care Compare: Home health agency

Medicare Care Compare
Listed as
Bluebonnet Health Services of WacoCCN 453141 · All quality measures
Overall star rating
3 of 5
Ownership
Proprietary
Certified
Aug 19, 2004
Medicare certification status
ActiveFrom the Provider of Services file
Services
Nursing, Medical social, Home health aide, Physical therapy, Speech pathology, Occupational therapy

Laboratory certificates & supplier records

Derived by NPIMap

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

CLIA laboratory certificates

CLIA numberLaboratoryCertificateExpires
45D1032679Waco Bluebonnet Holdings Inc720 N 64TH St, Waco, TX 76710Certificate of waiverOct 26, 2026

National Provider Directory

National Provider Directory
Tax ID family
Blue Bonnet Hospice Home Care Inc3 organizations share this tax ID, including this one

Other organizations with this tax ID 2

Organizations that report the same tax identification number in the National Provider Directory.

Ownership & related parties

All disclosed owners & managing parties 9

As disclosed on the Medicare enrollment (CMS All Owners files). Individuals include officers, directors and managing employees, who may not hold ownership.

NameRoleSinceShare
Holley Walsh Individual 5% Or Greater Indirect Ownership Interest Dec 1, 2015 7.5%
Brent McKenzie Individual Corporate OfficerSecretary/Treasurer Feb 9, 2023
Corporate DirectorDirector Dec 1, 2015
W-2 Managing EmployeeAdministrator Feb 1, 2023
Operational/Managerial ControlCfo Dec 1, 2015
Brent Wilson Individual 5% Or Greater Indirect Ownership Interest Feb 21, 2022 28.3%
Corporate OfficerPresident Feb 9, 2023
Corporate DirectorDirector Dec 1, 2015
Ryan Gibson Individual 5% Or Greater Indirect Ownership Interest May 1, 2023 5.67%
Corporate DirectorDirector Jan 31, 2023
Mike Dunham Individual 5% Or Greater Indirect Ownership Interest Feb 21, 2022 12.92%
Corporate DirectorDirector Jan 31, 2023
Michael Hillman Individual 5% Or Greater Indirect Ownership Interest Feb 21, 2022 28.3%
Corporate OfficerVice President Feb 9, 2023
Corporate DirectorDirector Feb 21, 2022
Mark Walsh Individual 5% Or Greater Indirect Ownership Interest Dec 1, 2015 7.5%
Mildus LLC Organization, Waco, TX LLC 5% Or Greater Indirect Ownership Interest Feb 21, 2022 12.92%
AMC Healthcare Holdings Inc Organization, Waco, TX Corporation 5% Or Greater Direct Ownership Interest Oct 25, 2013 100%

Facilities with the same owner 1

Facilities that share an organizational owner with 5% or greater ownership or operational control.

Practitioners & affiliated clinicians

Affiliated clinicians 18

Clinicians who list this facility as an affiliation in Medicare Care Compare.

View all 18

NPI Registry JSON

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

{
    "created_epoch": "1165190400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1503446400000",
    "number": "1629136742",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2020 N. VALLEY MILLS DR",
            "city": "WACO",
            "state": "TX",
            "postal_code": "76710"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2020 N VALLEY MILLS",
            "city": "WACO",
            "state": "TX",
            "postal_code": "767102561",
            "telephone_number": "254-772-5577",
            "fax_number": "254-772-5588"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "WACO BLUEBONNET HOLDINGS, INC.",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "AMC HEALTHCARE HOLDINGS, INC",
        "enumeration_date": "2006-12-04",
        "last_updated": "2017-08-23",
        "status": "A",
        "authorized_official_last_name": "MCKENZIE",
        "authorized_official_first_name": "BRENT",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "254-772-5577"
    },
    "taxonomies": [
        {
            "code": "251E00000X",
            "taxonomy_group": "",
            "desc": "Home Health",
            "state": "TX",
            "license": "008977",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "173233101",
            "state": "TX"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Bluebonnet Health Services of Waco",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Waco, TX

Sources for this page

Verify at the official NPI Registry.