MEDICARE: LUCKY ENTERPRISE

Medicare Provider Information

Scope of Practice

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

#	Taxonomy Code	Taxonomy
1	251X00000X	Supports Brokerage Agency
2	251E00000X	Home Health Agency
3	3747A0650X	Attendant Care Provider
4	251B00000X	Case Management Agency
5	3747P1801X	Personal Care Attendant

General Provider Information

NPI Number	:	1952620387
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	LUCKY ENTERPRISE

Provider Business Mailing Address
First Line	:	4510 HORIZON DR
Second Line	:
City	:	GARLAND
State	:	TX
Zip	:	75043-1869
Country	:	US
Telephone Number	:	972-303-2800
Fax Number	:	469-442-0647

Provider Business Practice Location Address
First Line	:	4510 HORIZON DR
Second Line	:
City	:	GARLAND
State	:	TX
Zip	:	75043-1869
Country	:	US
Telephone Number	:	972-303-2800
Fax Number	:	469-442-0647

Authorized Official
Title or Position	:	OWNER
Name	:	MR. GEOFFREY NZEADIBE
Credential	:
Telephone Number	:	972-303-2800

Provider Enumeration Date	:	05/25/2010
Last Update Date	:	06/10/2026

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Directions to “LUCKY ENTERPRISE ” Practice Location

Language	Start Address	Practice Location

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