=====================================================
General NPI Number Information
=====================================================
NPI Number | 1760202998
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | SILVER LANTERN HOMECARE LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 10/14/2024
-----------------------------------------------------
Last Update Date | 10/14/2024
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 30115 VERDANT CREEK DR
-----------------------------------------------------
City | FULSHEAR
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 77441-1627
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 832-368-1289
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 30115 VERDANT CREEK DR
-----------------------------------------------------
City | FULSHEAR
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 77441-1627
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 832-368-1289
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER/ADMINISTRATOR
-----------------------------------------------------
Name | MR. JOEL PUGH
-----------------------------------------------------
Credential | PT
-----------------------------------------------------
Telephone | 281-205-1010
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 253Z00000X
-----------------------------------------------------
Taxonomy Name | In Home Supportive Care Agency
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------