=====================================================
General NPI Number Information
=====================================================
NPI Number | 1821365958
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | LIFESTYLE PERSONAL CARE SERVICE
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 11/17/2011
-----------------------------------------------------
Last Update Date | 11/17/2011
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 9304 FOREST LANE SUITE N271
-----------------------------------------------------
City | DALLAS
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 75243
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 214-553-0277
-----------------------------------------------------
Fax | 972-584-9905
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 9304 FOREST LN STE N271
-----------------------------------------------------
City | DALLAS
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 75243-6238
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 214-553-0277
-----------------------------------------------------
Fax | 972-584-9905
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | DIRECTOR OF BUSINESS SERVICES
-----------------------------------------------------
Name | MR. DESMEIOUN L ALDRIDGE
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 214-553-0277
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 253Z00000X
-----------------------------------------------------
Taxonomy Name | In Home Supportive Care Agency
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------