Healthcare Provider Details

I. General information

NPI: 1285321471
Provider Name (Legal Business Name): MY GRANDPARENTS PLACE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/19/2023
Last Update Date: 04/19/2023
Certification Date: 04/19/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8748 BLOSSOM LN
DALLAS TX
75227-7205
US

IV. Provider business mailing address

8748 BLOSSOM LN
DALLAS TX
75227-7205
US

V. Phone/Fax

Practice location:
  • Phone: 214-482-0400
  • Fax:
Mailing address:
  • Phone: 214-482-0400
  • Fax:

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 Code315D00000X
TaxonomyInpatient Hospice
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code374U00000X
TaxonomyHome Health Aide
License Number
License Number State

VIII. Authorized Official

Name: SHAQUANNA JONES
Title or Position: OWNER
Credential:
Phone: 214-482-0400