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General NPI Number Information
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NPI Number | 1700165230
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Entity Type | Organization
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Legal Business Name | SOUTHWEST PERSONAL CARE
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Dates
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Enumeration Date | 08/15/2011
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Last Update Date | 08/15/2011
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Provider Practice Location Address
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Address Line | 5619 BELMONT AVE STE 209D
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City | DALLAS
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State | TX
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Zip | 75206-6701
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Country | US
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Telephone | 972-243-4920
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Fax | 972-243-4949
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Provider Business Mailing Address
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Address Line | 13505 WEBB CHAPEL RD STE 23
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City | FARMERS BRANCH
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State | TX
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Zip | 75234-5074
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Country | US
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Telephone | 972-243-4920
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Fax | 972-243-4949
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Authorized Official
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Title or Position | ADMINISTRATOR/OWNER
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Name | MS. JAMIE R WAKEFIELD
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Credential | RN
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Telephone | 214-790-1994
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 372600000X
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Taxonomy Name | Adult Companion
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License Number |
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License Number State |
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