=====================================================
General NPI Number Information
=====================================================
NPI Number | 1770351256
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | LIVING PROOF HOMEHEALTH CARE LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 12/14/2023
-----------------------------------------------------
Last Update Date | 12/14/2023
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 228 CALLAGHAN DR
-----------------------------------------------------
City | FATE
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 75189-4929
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 214-609-6349
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 228 CALLAGHAN DR
-----------------------------------------------------
City | FATE
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 75189-4929
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 214-609-6349
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | ADMINISTRATOR
-----------------------------------------------------
Name | PEACE SALAMI
-----------------------------------------------------
Credential | RN
-----------------------------------------------------
Telephone | 214-609-6349
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 251E00000X
-----------------------------------------------------
Taxonomy Name | Home Health Agency
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------