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General NPI Number Information
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NPI Number | 1578943312
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Entity Type | Organization
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Legal Business Name | SILVERTRAIL OMPASSION CAE.LLC
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Dates
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Enumeration Date | 06/07/2015
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Last Update Date | 06/07/2015
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Provider Practice Location Address
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Address Line | 2520 HEATHER BROOK LN APT 804
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City | ARLINGTON
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State | TX
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Zip | 76006-5177
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Country | US
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Telephone | 817-633-0383
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Fax | 817-633-0084
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Provider Business Mailing Address
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Address Line | PO BOX 540574
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City | GRAND PRAIRIE
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State | TX
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Zip | 75054-0574
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Country | US
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Telephone | 817-633-0383
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | MS. GRADA BERRY
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Credential |
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Telephone | 682-217-5822
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251E00000X
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Taxonomy Name | Home Health Agency
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License Number | 016187
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License Number State | TX
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