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General NPI Number Information
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NPI Number | 1770948176
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Entity Type | Organization
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Legal Business Name | IMIAH LLC
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Dates
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Enumeration Date | 12/29/2015
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Last Update Date | 12/03/2020
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Provider Practice Location Address
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Address Line | 7520 MARIETTA LN
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City | DALLAS
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State | TX
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Zip | 75241-4422
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Country | US
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Telephone | 469-236-4913
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Fax | 972-224-0088
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Provider Business Mailing Address
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Address Line | 1855 WINDSOR DR
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City | LANCASTER
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State | TX
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Zip | 75134-4148
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Country | US
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Telephone | 469-236-4913
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Fax | 972-224-0088
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Authorized Official
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Title or Position | OWNER
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Name | MRS. SAPRINA DOVELL WINB
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Credential |
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Telephone | 469-236-4913
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 311Z00000X
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Taxonomy Name | Custodial Care Facility
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License Number |
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License Number State |
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