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General NPI Number Information
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NPI Number | 1003427238
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Entity Type | Organization
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Legal Business Name | HERITAGE PRIDE LLC
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Dates
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Enumeration Date | 08/12/2020
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Last Update Date | 08/12/2020
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Provider Practice Location Address
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Address Line | 4730 FAIRMOUNT ST APT 4302
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City | DALLAS
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State | TX
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Zip | 75219-1144
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Country | US
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Telephone | 682-320-7070
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Fax |
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Provider Business Mailing Address
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Address Line | 4730 FAIRMOUNT ST APT 4302
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City | DALLAS
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State | TX
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Zip | 75219-1144
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Country | US
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Telephone | 682-320-7070
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Fax |
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Authorized Official
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Title or Position | PRESIDENT/ CEO
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Name | IKPONMWOSA ERIBO
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Credential |
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Telephone | 682-320-7070
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 253Z00000X
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Taxonomy Name | In Home Supportive Care Agency
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License Number |
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License Number State |
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