Healthcare Provider Details

I. General information

NPI: 1922485630
Provider Name (Legal Business Name): GEMS65 & OLDER PLUS MORE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/01/2015
Last Update Date: 05/11/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

325 N. ST. PAUL STE. 3100
DALLAS TX
75201
US

IV. Provider business mailing address

325 N. ST. PAUL STE. 3100
DALLAS TX
75201
US

V. Phone/Fax

Practice location:
  • Phone: 469-513-4064
  • Fax: 469-513-4001
Mailing address:
  • Phone: 469-513-4064
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code251V00000X
TaxonomyVoluntary or Charitable Agency
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code343900000X
TaxonomyNon-emergency Medical Transport (VAN)
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code347C00000X
TaxonomyPrivate Vehicle
License Number
License Number State

VIII. Authorized Official

Name: MS. STEPHANIE JACKSON
Title or Position: DIRECTOR
Credential:
Phone: 469-513-4064