=====================================================
General NPI Number Information
=====================================================
NPI Number | 1053099200
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | SILBAS CARE
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 07/07/2023
-----------------------------------------------------
Last Update Date | 07/07/2023
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 11822 GARDEN TERRACE DR
-----------------------------------------------------
City | DALLAS
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 75243-5000
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 682-716-1700
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 10931 STONE CANYON RD APT 240
-----------------------------------------------------
City | DALLAS
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 75230-4338
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 214-554-0202
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | ADMINISTRATOR
-----------------------------------------------------
Name | MR. SILAS EHIMEN
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 214-554-0202
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 311ZA0620X
-----------------------------------------------------
Taxonomy Name | Adult Care Home Facility
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------