Healthcare Provider Details

I. General information

NPI: 1467788471
Provider Name (Legal Business Name): LAYOLA HEALTH SERVICES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/26/2009
Last Update Date: 10/26/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2306 MONTEGO DR
ARLINGTON TX
76002-4007
US

IV. Provider business mailing address

2306 MONTEGO DR
ARLINGTON TX
76002-4007
US

V. Phone/Fax

Practice location:
  • Phone: 817-323-9981
  • Fax: 972-264-5540
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251B00000X
TaxonomyCase Management Agency
License Number
License Number State

VIII. Authorized Official

Name: MICHAEL SHORUNKE
Title or Position: ADMINISTRATOR
Credential:
Phone: 817-323-9981