=====================================================
General NPI Number Information
=====================================================
NPI Number | 1609101526
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | VIA CARE HOME HEALTH SERVICES LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 10/09/2009
-----------------------------------------------------
Last Update Date | 10/09/2009
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 2410 TAYLOR ST SUITE 22419
-----------------------------------------------------
City | DALLAS
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 75201-8452
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 972-795-4264
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 2410 TAYLOR ST SUITE 22419
-----------------------------------------------------
City | DALLAS
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 75201-8452
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 972-795-4264
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | ADMINISTRATOR
-----------------------------------------------------
Name | MS. BENI DELOACH
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 972-795-4264
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 251E00000X
-----------------------------------------------------
Taxonomy Name | Home Health Agency
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------