=====================================================
General NPI Number Information
=====================================================
NPI Number | 1528634029
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | SENIOR SHIELD HOME CARE, LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 06/03/2021
-----------------------------------------------------
Last Update Date | 06/03/2021
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1333 W MCDERMOTT DR STE 236
-----------------------------------------------------
City | ALLEN
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 75013-3089
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 972-454-1938
-----------------------------------------------------
Fax | 346-301-3143
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 2775 VILLA CREEK DR STE 219
-----------------------------------------------------
City | DALLAS
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 75234-7613
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 469-988-2144
-----------------------------------------------------
Fax | 346-301-3143
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PRESIDENT
-----------------------------------------------------
Name | MR. VINCENT THOMPSON JR.
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 469-988-2144
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 253Z00000X
-----------------------------------------------------
Taxonomy Name | In Home Supportive Care Agency
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------