Healthcare Provider Details

I. General information

NPI: 1609465541
Provider Name (Legal Business Name): WHITES EXECUTIVE PATIENT HOME CARE LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/14/2021
Last Update Date: 01/14/2021
Certification Date: 01/14/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1220 RIVER BEND DR STE 116
DALLAS TX
75247-4996
US

IV. Provider business mailing address

1220 RIVER BEND DR STE 116
DALLAS TX
75247-4996
US

V. Phone/Fax

Practice location:
  • Phone: 214-600-4081
  • Fax: 866-224-2441
Mailing address:
  • Phone: 214-600-4081
  • Fax: 866-224-2441

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 Code3747A0650X
TaxonomyAttendant Care Provider
License Number
License Number State

VIII. Authorized Official

Name: JAKIYA S JENKINS
Title or Position: OWNER
Credential:
Phone: 214-600-4081