Healthcare Provider Details

I. General information

NPI: 1629893458
Provider Name (Legal Business Name): PROUD MOM SOLUTIONS LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/18/2024
Last Update Date: 11/18/2024
Certification Date: 11/18/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

800 BUFFALO CT
CROWLEY TX
76036-3912
US

IV. Provider business mailing address

800 BUFFALO CT
CROWLEY TX
76036-3912
US

V. Phone/Fax

Practice location:
  • Phone: 817-874-9044
  • Fax: 817-549-2986
Mailing address:
  • Phone: 817-874-9044
  • Fax: 817-549-2986

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code253Z00000X
TaxonomyIn Home Supportive Care Agency
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code374U00000X
TaxonomyHome Health Aide
License Number
License Number State

VIII. Authorized Official

Name: GRACE EWANG
Title or Position: OWNER
Credential:
Phone: 256-585-4222