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General NPI Number Information
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NPI Number | 1568727691
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Entity Type | Organization
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Legal Business Name | FLOWER MOUND HOMECARE LLC
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Dates
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Enumeration Date | 07/04/2012
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Last Update Date | 02/12/2013
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Provider Practice Location Address
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Address Line | 4100 MORRISS RD APT 225
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City | FLOWER MOUND
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State | TX
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Zip | 75028-1841
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Country | US
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Telephone | 469-583-6218
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Fax |
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Provider Business Mailing Address
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Address Line | 4100 MORRISS RD APT 225
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City | FLOWER MOUND
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State | TX
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Zip | 75028-1841
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | ADMINISTRATOR
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Name | OSARU IYAMU
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Credential | LVN
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Telephone | 469-583-6218
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 3747P1801X
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Taxonomy Name | Personal Care Attendant
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License Number | 015227
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License Number State | TX
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