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General NPI Number Information
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NPI Number | 1720496409
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Entity Type | Organization
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Legal Business Name | SHALOM COKER 24 HOURS SPECIAL NEEDS DAYCARE
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Dates
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Enumeration Date | 07/25/2014
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Last Update Date | 07/25/2014
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Provider Practice Location Address
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Address Line | 3103 GREGORY LN
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City | GRAND PRAIRIE
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State | TX
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Zip | 75052-5742
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Country | US
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Telephone | 972-374-6955
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Fax |
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Provider Business Mailing Address
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Address Line | 3103 GREGORY LN
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City | GRAND PRAIRIE
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State | TX
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Zip | 75052-5742
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Country | US
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Telephone | 972-374-6955
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Fax |
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Authorized Official
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Title or Position | PRESIDENT AND CEO
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Name | SHALOM OSUNDE
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Credential |
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Telephone | 972-374-6955
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 315P00000X
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Taxonomy Name | Intellectual Disabilities Intermediate Care Facility
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License Number | LVN#221824
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License Number State | TX
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