Healthcare Provider Details

I. General information

NPI: 1578281739
Provider Name (Legal Business Name): PANORAMA CARE HOME LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/15/2022
Last Update Date: 07/23/2024
Certification Date: 07/23/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6403 LOTUS DR
ARLINGTON TX
76001-7413
US

IV. Provider business mailing address

6403 LOTUS DR
ARLINGTON TX
76001-7413
US

V. Phone/Fax

Practice location:
  • Phone: 682-336-1943
  • Fax:
Mailing address:
  • Phone: 682-336-1943
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code311Z00000X
TaxonomyCustodial Care Facility
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code311ZA0620X
TaxonomyAdult Care Home Facility
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code343900000X
TaxonomyNon-emergency Medical Transport (VAN)
License Number
License Number State
# 5
Primary TaxonomyY
Taxonomy Code310400000X
TaxonomyAssisted Living Facility
License Number
License Number State

VIII. Authorized Official

Name: MS. DIANA RICKETTS
Title or Position: ADMINISTRATOR
Credential:
Phone: 682-336-1943