Healthcare Provider Details

I. General information

NPI: 1215577903
Provider Name (Legal Business Name): SELAH NEUROLOGICAL RESPITE CARE, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/09/2020
Last Update Date: 05/05/2020
Certification Date: 05/05/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2626 COLE AVE STE 300
DALLAS TX
75204-1094
US

IV. Provider business mailing address

2626 COLE AVE STE 300
DALLAS TX
75204-1094
US

V. Phone/Fax

Practice location:
  • Phone: 214-865-8343
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code385H00000X
TaxonomyRespite Care
License Number
License Number State

VIII. Authorized Official

Name: SHAUDAE MCMILLAN
Title or Position: CEO
Credential:
Phone: 216-644-1871