=====================================================
General NPI Number Information
=====================================================
NPI Number | 1306983309
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | SCOF ENTERPRISE INC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 01/31/2007
-----------------------------------------------------
Last Update Date | 11/18/2024
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1201 N WATSON RD STE 268
-----------------------------------------------------
City | ARLINGTON
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 76006-6222
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 817-459-1220
-----------------------------------------------------
Fax | 817-459-1224
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 1201 N WATSON RD STE 268
-----------------------------------------------------
City | ARLINGTON
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 76006-6222
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 817-459-1220
-----------------------------------------------------
Fax | 817-459-1224
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | ALT. ADMINISTRATOR
-----------------------------------------------------
Name | MR. FRIDAY AIGBEDION
-----------------------------------------------------
Credential | RN
-----------------------------------------------------
Telephone | 817-459-1220
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 251E00000X
-----------------------------------------------------
Taxonomy Name | Home Health Agency
-----------------------------------------------------
License Number | 010897
-----------------------------------------------------
License Number State | TX
-----------------------------------------------------