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NPI Code Detail

MEDICARE: SELAH NEUROLOGICAL RESPITE CARE, LLC

MEDICARE: SELAH NEUROLOGICAL RESPITE CARE, LLC
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
1385H00000XRespite Care

General Provider Information

NPI Number : 1215577903
Entity Type Code : Organization
Provider Name (Legal Business Name) : SELAH NEUROLOGICAL RESPITE CARE, LLC
Provider Business Mailing Address
First Line : 2626 COLE AVE STE 300
Second Line :
City : DALLAS
State : TX
Zip : 75204-1094
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 2626 COLE AVE STE 300
Second Line :
City : DALLAS
State : TX
Zip : 75204-1094
Country : US
Telephone Number : 214-865-8343
Fax Number :
Authorized Official
Title or Position : CEO
Name : SHAUDAE MCMILLAN
Credential :
Telephone Number : 216-644-1871
Provider Enumeration Date : 01/09/2020
Last Update Date : 05/05/2020

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Directions to “SELAH NEUROLOGICAL RESPITE CARE, LLC ” Practice Location

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