=====================================================
General NPI Number Information
=====================================================
NPI Number | 1578836789
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | BISHOP HOMECARE
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 02/17/2012
-----------------------------------------------------
Last Update Date | 02/17/2012
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 724 CHALK HILL LN
-----------------------------------------------------
City | DESOTO
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 75115-5110
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 214-881-2192
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 724 CHALK HILL LN
-----------------------------------------------------
City | DESOTO
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 75115-5110
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 214-881-2192
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | ADMINISTRATOR/OWNER
-----------------------------------------------------
Name | GWENNETTA M WOOLDRIDGE
-----------------------------------------------------
Credential | RN
-----------------------------------------------------
Telephone | 214-881-2192
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 253Z00000X
-----------------------------------------------------
Taxonomy Name | In Home Supportive Care Agency
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------