=====================================================
General NPI Number Information
=====================================================
NPI Number | 1114034683
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | FAMILY DESIRE HOME HEALTH SERVICES
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 08/23/2006
-----------------------------------------------------
Last Update Date | 07/21/2022
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 3530 FOREST LN STE 314
-----------------------------------------------------
City | DALLAS
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 75234-7910
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 214-819-1729
-----------------------------------------------------
Fax | 214-351-6140
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 3530 FOREST LN # 314
-----------------------------------------------------
City | DALLAS
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 75234-7910
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 214-819-1729
-----------------------------------------------------
Fax | 214-351-6140
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | ADMINISTRATOR
-----------------------------------------------------
Name | MRS. MARY CYPRIAN ESSIEN
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 214-819-1729
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 251E00000X
-----------------------------------------------------
Taxonomy Name | Home Health Agency
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State | TX
-----------------------------------------------------