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General NPI Number Information
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NPI Number | 1245592351
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Entity Type | Organization
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Legal Business Name | LOYALTY AT HOME FAMILY SERVICES
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Dates
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Enumeration Date | 06/13/2012
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Last Update Date | 06/13/2012
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Provider Practice Location Address
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Address Line | 2116 MARSH LN APT. 303
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City | CARROLLTON
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State | TX
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Zip | 75006-4957
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Country | US
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Telephone | 319-899-9327
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Fax | 469-892-5608
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Provider Business Mailing Address
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Address Line | 2116 MARSH LN APT. 303
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City | CARROLLTON
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State | TX
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Zip | 75006-4957
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Country | US
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Telephone | 319-899-9327
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Fax | 469-892-5608
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Authorized Official
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Title or Position | OWNER
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Name | MR. MATTHEW JAMES GERLEMAN
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Credential |
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Telephone | 319-899-9327
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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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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