MEDICARE: PILDASH LIVING HOME, INC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	311ZA0620X	Adult Care Home Facility

General Provider Information

NPI Number	:	1053084541
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	PILDASH LIVING HOME, INC

Provider Business Mailing Address
First Line	:	1010 E ARKANSAS LN
Second Line	:
City	:	ARLINGTON
State	:	TX
Zip	:	76014-1363
Country	:	US
Telephone Number	:	682-365-7517
Fax Number	:	817-523-8807

Provider Business Practice Location Address
First Line	:	1010 E ARKANSAS LN
Second Line	:
City	:	ARLINGTON
State	:	TX
Zip	:	76014-1363
Country	:	US
Telephone Number	:	682-365-7517
Fax Number	:	817-523-8807

Authorized Official
Title or Position	:	MANAGER
Name	:	RUBBY ADELE
Credential	:
Telephone Number	:	682-365-7517

Provider Enumeration Date	:	07/29/2021
Last Update Date	:	07/29/2021

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