Healthcare Provider Details

I. General information

NPI: 1093709727
Provider Name (Legal Business Name): VPH SENIOR CARE, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/08/2005
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11409 N CENTRAL EXPY
DALLAS TX
75243-6678
US

IV. Provider business mailing address

1500 WATERS RIDGE DR SUITE 200
LEWISVILLE TX
75057-6011
US

V. Phone/Fax

Practice location:
  • Phone: 214-363-5100
  • Fax: 214-363-5133
Mailing address:
  • Phone: 972-899-4401
  • Fax: 972-899-4460

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code310400000X
TaxonomyAssisted Living Facility
License Number115516
License Number StateTX

VIII. Authorized Official

Name: DAN STANSBURY JR.
Title or Position: AUTHORIZED OFFICER
Credential:
Phone: 214-696-3495