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General NPI Number Information
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NPI Number | 1700066610
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Entity Type | Organization
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Legal Business Name | EL SHADAI CARE HOME
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Dates
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Enumeration Date | 11/08/2007
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Last Update Date | 11/08/2007
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Provider Practice Location Address
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Address Line | 1225 NUTTING ST
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City | CEDAR HILL
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State | TX
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Zip | 75104-8135
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Country | US
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Telephone | 972-291-7445
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Fax | 972-291-3176
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Provider Business Mailing Address
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Address Line | 1225 NUTTING ST
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City | CEDAR HILL
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State | TX
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Zip | 75104-8135
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Country | US
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Telephone | 972-291-7445
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Fax | 972-291-3176
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Authorized Official
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Title or Position | OWNER
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Name | ELIZABETH O AYORINDE
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Credential |
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Telephone | 214-715-5725
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 310400000X
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Taxonomy Name | Assisted Living Facility
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License Number | 121949
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License Number State | TX
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