=====================================================
General NPI Number Information
=====================================================
NPI Number | 1437462371
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | LIVESTRONG HOME HEALTH
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 07/20/2010
-----------------------------------------------------
Last Update Date | 07/20/2010
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 5218 VICKERY BLVD
-----------------------------------------------------
City | DALLAS
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 75206-6227
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 214-803-2877
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 5218 VICKERY BLVD
-----------------------------------------------------
City | DALLAS
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 75206-6227
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 214-803-2877
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PRESIDENT
-----------------------------------------------------
Name | MRS. DESIREE NICOLE PEREZ
-----------------------------------------------------
Credential | PT
-----------------------------------------------------
Telephone | 214-803-2877
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 251E00000X
-----------------------------------------------------
Taxonomy Name | Home Health Agency
-----------------------------------------------------
License Number | 1162509
-----------------------------------------------------
License Number State | TX
-----------------------------------------------------