Healthcare Provider Details

I. General information

NPI: 1316783855
Provider Name (Legal Business Name): STAFFING LOUNGE, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/03/2024
Last Update Date: 07/16/2024
Certification Date: 07/16/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1910 PACIFIC AVE STE 6050
DALLAS TX
75201-4558
US

IV. Provider business mailing address

1910 PACIFIC AVE STE 6050
DALLAS TX
75201-4558
US

V. Phone/Fax

Practice location:
  • Phone: 214-258-5185
  • Fax:
Mailing address:
  • Phone: 214-258-5185
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QC1500X
TaxonomyCommunity Health Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: ASHLEY RIDER
Title or Position: OPERATIONS DIRECTOR
Credential:
Phone: 214-258-5185