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General NPI Number Information
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NPI Number | 1740614478
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Entity Type | Organization
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Legal Business Name | THE LORD'S TALENTS LLC
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Dates
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Enumeration Date | 08/29/2013
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Last Update Date | 08/29/2013
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Provider Practice Location Address
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Address Line | 5555 N LAMAR BLVD STE K100
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City | AUSTIN
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State | TX
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Zip | 78751-1063
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Country | US
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Telephone | 512-310-2273
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Fax |
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Provider Business Mailing Address
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Address Line | 912 LITTLE BEAR RD
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City | BUDA
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State | TX
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Zip | 78610-3041
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | MR. JASON L GIBERT
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Credential |
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Telephone | 512-295-9200
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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 | 013590
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License Number State | TX
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