MEDICARE: DYNASTY HOME 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
1	3747P1801X	Personal Care Attendant

General Provider Information

NPI Number	:	1649117748
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	DYNASTY HOME CARE LLC

Provider Business Mailing Address
First Line	:	17446 S SUMMIT CANYON DR
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77095-6948
Country	:	US
Telephone Number	:	346-550-8559
Fax Number	:	346-413-6029

Provider Business Practice Location Address
First Line	:	17446 S SUMMIT CANYON DR
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77095-6948
Country	:	US
Telephone Number	:	346-550-8559
Fax Number	:	346-413-6029

Authorized Official
Title or Position	:	ADMINISTRATOR
Name	:	DOLLIE NELSON
Credential	:
Telephone Number	:	346-332-3182

Provider Enumeration Date	:	04/29/2026
Last Update Date	:	04/29/2026

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Directions to “DYNASTY HOME CARE LLC ” Practice Location

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