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General NPI Number Information
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NPI Number | 1902196546
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Entity Type | Organization
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Legal Business Name | DERA HEALTHCARE SYSTEM INC.
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Dates
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Enumeration Date | 04/16/2011
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Last Update Date | 04/16/2011
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Provider Practice Location Address
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Address Line | 628 SNAPDRAGON LN
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City | DESOTO
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State | TX
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Zip | 75115-6658
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Country | US
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Telephone | 972-223-9955
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Fax | 972-223-9955
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Provider Business Mailing Address
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Address Line | 628 SNAPDRAGON LN
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City | DESOTO
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State | TX
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Zip | 75115-6658
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Country | US
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Telephone | 972-223-9955
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Fax | 972-223-9955
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Authorized Official
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Title or Position | ADMINISTRATOR AND OWNER
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Name | MRS. IFEOMA LOUISA UZOMAH
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Credential |
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Telephone | 972-223-9955
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251E00000X
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Taxonomy Name | Home Health Agency
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License Number |
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License Number State |
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