Healthcare Provider Details

I. General information

NPI: 1952966632
Provider Name (Legal Business Name): SKPK 2000 GROUP LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/07/2019
Last Update Date: 12/01/2020
Certification Date: 12/01/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5717 LEGACY DR STE 250
PLANO TX
75024-4246
US

IV. Provider business mailing address

4251 POROSA LN
PROSPER TX
75078-0326
US

V. Phone/Fax

Practice location:
  • Phone: 214-930-3074
  • Fax:
Mailing address:
  • Phone: 214-970-0203
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License Number
License Number State

VIII. Authorized Official

Name: KRISTIN SINES
Title or Position: OWNER
Credential:
Phone: 214-970-0203