Bandera Healthcare LLC

Primary specialty

Skilled Nursing FacilityTaxonomy code 314000000X

Legal business name

BANDERA HEALTHCARE LLC

Practice address

29222 Rancho Viejo Rd Ste 127
San Juan Capistrano, CA 92675

Phone

(949) 487-9500

Fax

(949) 540-1966

NPI assigned

May 9, 2018

Last updated

Jun 29, 2020By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Soon Burnam

Title

Treasurer

Phone

(949) 540-1249

Specialties & licenses 1

Addresses

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

{
    "created_epoch": "1525824000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1593388800000",
    "number": "1841789336",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "29222 RANCHO VIEJO RD STE 127",
            "city": "SAN JUAN CAPISTRANO",
            "state": "CA",
            "postal_code": "926751049",
            "telephone_number": "949-487-9500",
            "fax_number": "949-540-1966"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "29222 RANCHO VIEJO RD STE 127",
            "city": "SAN JUAN CAPISTRANO",
            "state": "CA",
            "postal_code": "92675",
            "telephone_number": "949-487-9500",
            "fax_number": "949-540-1966"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "27101 Puerta Real Ste 450",
            "address_purpose": "LOCATION",
            "city": "Mission Viejo",
            "state": "CA",
            "postal_code": "926918566",
            "country_code": "US",
            "telephone_number": "949-487-9500",
            "fax_number": "949-540-1966",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "organization_name": "BANDERA HEALTHCARE LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2018-05-09",
        "last_updated": "2020-06-29",
        "certification_date": "2020-06-29",
        "status": "A",
        "authorized_official_last_name": "BURNAM",
        "authorized_official_first_name": "SOON",
        "authorized_official_title_or_position": "TREASURER",
        "authorized_official_telephone_number": "949-540-1249"
    },
    "taxonomies": [
        {
            "code": "314000000X",
            "taxonomy_group": "",
            "desc": "Skilled Nursing Facility",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Kelsey Haunani Bains, ATC, CPM, LM
• Carolynn Marie Baker, MA, BCBA
• Juliet Kathryne Ballard
• Thomas Byron Ballard Jr., PH.D.
• Lisa Bancroft, BCBA
• Grace Barkema, AMFT
• Annamarie Helen Barsoe, MFT
• Paul Gregory Batchelor
• Kristen Elizabeth Baumberger, OTR/L
• Jeremy Bautista

• Skilled Nursing Facility in San Juan Capistrano, CA
• Providers in San Juan Capistrano, CA by specialty
• Skilled Nursing Facility in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 29, 2020; 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.