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General NPI Number Information
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NPI Number | 1346724275
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Entity Type | Organization
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Legal Business Name | DOMINION HOME CARE LLC
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Dates
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Enumeration Date | 09/17/2018
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Last Update Date | 09/17/2018
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Provider Practice Location Address
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Address Line | 3106 CENTENNIAL DR
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City | GARLAND
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State | TX
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Zip | 75042-5501
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Country | US
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Telephone | 214-778-9052
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Fax |
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Provider Business Mailing Address
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Address Line | 3035 BROOKSHIRE DR
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City | PLANO
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State | TX
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Zip | 75075-7645
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Country | US
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Telephone | 214-778-9052
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | ABIODUN GLORIA IRABOR-MUSA
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Credential |
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Telephone | 214-778-9052
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 320900000X
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Taxonomy Name | Intellectual and/or Developmental Disabilities Community Based Residential Treatment Facility
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License Number |
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License Number State |
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