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General NPI Number Information
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NPI Number | 1407151533
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Entity Type | Organization
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Legal Business Name | SHIELD OF FAITH ASSISTED LIVING
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Dates
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Enumeration Date | 01/20/2011
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Last Update Date | 01/20/2011
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Provider Practice Location Address
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Address Line | 1206 DEERWOOD DR
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City | DALLAS
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State | TX
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Zip | 75232-3822
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Country | US
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Telephone | 972-333-6282
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Fax |
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Provider Business Mailing Address
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Address Line | 6611 GREENSPAN AVE
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City | DALLAS
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State | TX
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Zip | 75232-3605
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Country | US
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Telephone | 972-333-6282
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | MRS. DENETTA JEAN SMITH
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Credential |
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Telephone | 972-333-6282
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 310400000X
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Taxonomy Name | Assisted Living Facility
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License Number | 131060
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License Number State | TX
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