=====================================================
General NPI Number Information
=====================================================
NPI Number | 1902103856
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | LIVING AND COMMUNITY ASSISTANT SSERVICES
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 02/11/2011
-----------------------------------------------------
Last Update Date | 02/11/2011
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 10935 ESTATE LN STE 340
-----------------------------------------------------
City | DALLAS
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 75238-5193
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 214-234-0621
-----------------------------------------------------
Fax | 214-341-0655
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 10935 ESTATE LN STE 340
-----------------------------------------------------
City | DALLAS
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 75238-5193
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 214-234-0621
-----------------------------------------------------
Fax | 214-341-0655
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PRESIDENT
-----------------------------------------------------
Name | VERONICA N SAM
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 214-234-0621
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 251S00000X
-----------------------------------------------------
Taxonomy Name | Community/Behavioral Health Agency
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------