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General NPI Number Information
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NPI Number | 1538531348
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Entity Type | Organization
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Legal Business Name | GIFT OF LIFE COMMUNITY HOME
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Dates
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Enumeration Date | 10/20/2015
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Last Update Date | 10/20/2015
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Provider Practice Location Address
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Address Line | 6510 VIRGINIA PKWY 108
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City | MCKINNEY
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State | TX
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Zip | 75071-5510
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Country | US
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Telephone | 817-691-7238
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Fax | 888-959-2093
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Provider Business Mailing Address
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Address Line | 3220 GRANT ST
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City | MCKINNEY
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State | TX
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Zip | 75071-2990
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Country | US
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Telephone | 817-691-7238
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Fax | 888-959-2093
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Authorized Official
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Title or Position | CEO
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Name | YOLANDA VASHUND HENDERSON
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Credential | N.D, CHHC
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Telephone | 817-691-7238
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 253Z00000X
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Taxonomy Name | In Home Supportive Care Agency
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License Number |
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License Number State | TX
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Taxonomy #2
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Taxonomy Code | 320700000X
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Taxonomy Name | Physical Disabilities Residential Treatment Facility
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License Number |
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License Number State | TX
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Taxonomy #3
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Taxonomy Code | 252Y00000X
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Taxonomy Name | Early Intervention Provider Agency
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License Number |
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License Number State | TX
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