=====================================================
General NPI Number Information
=====================================================
NPI Number | 1255869228
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | CARING HEARTS PEDIATRIC SERVICES LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 06/02/2017
-----------------------------------------------------
Last Update Date | 07/21/2022
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 10935 ESTATE LN STE 241
-----------------------------------------------------
City | DALLAS
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 75238-5181
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 469-920-0998
-----------------------------------------------------
Fax | 972-329-2188
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 10935 ESTATE LN STE 241
-----------------------------------------------------
City | DALLAS
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 75238-5181
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 972-329-0036
-----------------------------------------------------
Fax | 972-329-2188
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | MANAGER
-----------------------------------------------------
Name | FLORENCE DAVIES-COLE
-----------------------------------------------------
Credential | RN
-----------------------------------------------------
Telephone | 469-920-0998
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 251E00000X
-----------------------------------------------------
Taxonomy Name | Home Health Agency
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------