Healthcare Provider Details

I. General information

NPI: 1992671135
Provider Name (Legal Business Name): NOVACARE CONNECT LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/15/2025
Last Update Date: 10/22/2025
Certification Date: 10/22/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

209 S SHADY SHORES DR STE 300-2004
LAKE DALLAS TX
75065-2973
US

IV. Provider business mailing address

209 S SHADY SHORES DR STE 300-2004
LAKE DALLAS TX
75065-2973
US

V. Phone/Fax

Practice location:
  • Phone: 940-300-4858
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code163WN1003X
TaxonomyNutrition Support Registered Nurse
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code251J00000X
TaxonomyNursing Care Agency
License Number
License Number State
# 5
Primary TaxonomyY
Taxonomy Code261QM2500X
TaxonomyMedical Specialty Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: ZEKIELA RILEY
Title or Position: OWNER
Credential: RN
Phone: 940-300-4858