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General NPI Number Information
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NPI Number | 1245364686
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Entity Type | Organization
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Legal Business Name | D J MONTGOMERY ENTERPRISE, LLC
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Dates
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Enumeration Date | 03/16/2007
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Last Update Date | 07/06/2010
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Provider Practice Location Address
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Address Line | 860 HEBRON PKWY SUITE 703 & 704
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City | LEWISVILLE
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State | TX
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Zip | 75057-5151
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Country | US
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Telephone | 972-459-9264
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Fax | 214-260-1140
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Provider Business Mailing Address
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Address Line | 860 HEBRON PKWY SUITE 703 & 704
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City | LEWISVILLE
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State | TX
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Zip | 75057-5151
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Country | US
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Telephone | 972-459-9264
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Fax | 214-260-1140
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Authorized Official
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Title or Position | OWNER PRESIDENT
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Name | MS. DARLA JEANETTE MONTGOMERY
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Credential | NONE
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Telephone | 972-459-9264
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251E00000X
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Taxonomy Name | Home Health Agency
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License Number | 009728
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License Number State | TX
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