Healthcare Provider Details

I. General information

NPI: 1023727120
Provider Name (Legal Business Name): DALLAS HOME CARE AGENCY LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/16/2022
Last Update Date: 11/16/2022
Certification Date: 11/16/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

324 E BELT LINE RD STE 400
DESOTO TX
75115-5706
US

IV. Provider business mailing address

324 E BELT LINE RD STE 400
DESOTO TX
75115-5706
US

V. Phone/Fax

Practice location:
  • Phone: 469-998-4300
  • Fax: 469-998-4300
Mailing address:
  • Phone: 469-998-4300
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code253Z00000X
TaxonomyIn Home Supportive Care Agency
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code320900000X
TaxonomyIntellectual and/or Developmental Disabilities Community Based Residential Treatment Facility
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code385HR2065X
TaxonomyChild Physical Disabilities Respite Care
License Number
License Number State
# 4
Primary TaxonomyY
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License Number
License Number State

VIII. Authorized Official

Name: SHERRILYN WILLIAMS
Title or Position: DIRECTOR OF HOME CARE
Credential:
Phone: 469-998-4300