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General NPI Number Information
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NPI Number | 1588430813
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Entity Type | Organization
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Legal Business Name | PROVIDENCE SENIOR SERVICES, LLC
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Dates
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Enumeration Date | 11/28/2023
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Last Update Date | 11/28/2023
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Provider Practice Location Address
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Address Line | 13101 PRESTON RD STE 515
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City | DALLAS
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State | TX
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Zip | 75240-5234
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Country | US
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Telephone | 972-739-8886
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Fax | 972-767-4209
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Provider Business Mailing Address
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Address Line | 13101 PRESTON RD STE 515
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City | DALLAS
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State | TX
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Zip | 75240-5234
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Country | US
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Telephone | 972-739-8886
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Fax | 972-767-4209
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Authorized Official
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Title or Position | OWNER/ADMINISTRATOR
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Name | MARCUS J GARDNER
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Credential |
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Telephone | 972-793-8886
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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 |
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