Healthcare Provider Details

I. General information

NPI: 1538531348
Provider Name (Legal Business Name): GIFT OF LIFE COMMUNITY HOME
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/20/2015
Last Update Date: 10/20/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6510 VIRGINIA PKWY 108
MCKINNEY TX
75071-5510
US

IV. Provider business mailing address

3220 GRANT ST
MCKINNEY TX
75071-2990
US

V. Phone/Fax

Practice location:
  • Phone: 817-691-7238
  • Fax: 888-959-2093
Mailing address:
  • Phone: 817-691-7238
  • Fax: 888-959-2093

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code253Z00000X
TaxonomyIn Home Supportive Care Agency
License Number
License Number StateTX
# 2
Primary TaxonomyN
Taxonomy Code320700000X
TaxonomyPhysical Disabilities Residential Treatment Facility
License Number
License Number StateTX
# 3
Primary TaxonomyY
Taxonomy Code252Y00000X
TaxonomyEarly Intervention Provider Agency
License Number
License Number StateTX

VIII. Authorized Official

Name: YOLANDA VASHUND HENDERSON
Title or Position: CEO
Credential: N.D, CHHC
Phone: 817-691-7238