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General NPI Number Information
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NPI Number | 1154220804
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Entity Type | Organization
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Legal Business Name | PREMIER HEARTS RESIDENTIAL LIVING
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Dates
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Enumeration Date | 11/02/2026
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Last Update Date | 11/02/2026
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Provider Practice Location Address
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Address Line | 148 BUSHEL LN
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City | DALLAS
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State | TX
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Zip | 75241-5334
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Country | US
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Telephone | 214-306-3747
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Fax |
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Provider Business Mailing Address
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Address Line | 148 BUSHEL LN
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City | DALLAS
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State | TX
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Zip | 75241-5334
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Country | US
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Telephone | 214-306-3747
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Fax |
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Authorized Official
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Title or Position | MANGER
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Name | MARY ELLEN DEDMOND-GRIFFIN
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Credential |
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Telephone | 214-306-3747
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 174200000X
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Taxonomy Name | Meals Provider
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 177F00000X
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Taxonomy Name | Lodging Provider
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 251C00000X
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Taxonomy Name | Developmentally Disabled Services Day Training Agency
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License Number |
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License Number State |
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