MEDICARE: INTERIM HEALTHCARE OF DALLAS LP

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	251E00000X	Home Health Agency	7640	TX

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	7640	OTHER	TX	STATE LICENCE NUMBER

General Provider Information

NPI Number	:	1891744033
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	INTERIM HEALTHCARE OF DALLAS LP

Provider Business Mailing Address
First Line	:	12750 MERIT DR
Second Line	:	SUITE 110
City	:	DALLAS
State	:	TX
Zip	:	75251-1214
Country	:	US
Telephone Number	:	214-360-9090
Fax Number	:	214-987-4384

Provider Business Practice Location Address
First Line	:	12750 MERIT DR
Second Line	:	SUITE 110
City	:	DALLAS
State	:	TX
Zip	:	75251-1214
Country	:	US
Telephone Number	:	214-360-9090
Fax Number	:	214-987-4384

Authorized Official
Title or Position	:	PRESIDENT
Name	:	MR. JOSEPH S JOHNSON
Credential	:
Telephone Number	:	918-749-9933

Provider Enumeration Date	:	05/06/2006
Last Update Date	:	10/03/2011

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