=====================================================
General NPI Number Information
=====================================================
NPI Number | 1073023768
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | DFW MULTI SERVICES, LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 10/07/2017
-----------------------------------------------------
Last Update Date | 10/07/2017
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 2209 CORNERSTONE LN APT 3012
-----------------------------------------------------
City | ARLINGTON
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 76013-6161
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 817-504-8252
-----------------------------------------------------
Fax | 817-945-9978
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 2209 CORNERSTONE LN APT 3012
-----------------------------------------------------
City | ARLINGTON
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 76013-6161
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 817-504-8252
-----------------------------------------------------
Fax | 817-945-9978
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | MANAGING PARTNER & FOUNDER
-----------------------------------------------------
Name | MR. NATHANIEL AKOI GOUN
-----------------------------------------------------
Credential | MBA , CFE
-----------------------------------------------------
Telephone | 817-504-8252
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 251E00000X
-----------------------------------------------------
Taxonomy Name | Home Health Agency
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State | TX
-----------------------------------------------------