=====================================================
General NPI Number Information
=====================================================
NPI Number | 1982904124
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | THERAVENTION LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 10/21/2010
-----------------------------------------------------
Last Update Date | 01/04/2011
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 2850 SHORELINE TRL # 100
-----------------------------------------------------
City | ROCKWALL
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 75032-5513
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 214-718-0226
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 2850 SHORELINE TRL # 100
-----------------------------------------------------
City | ROCKWALL
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 75032-5513
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 214-718-0226
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | CO-OWNER
-----------------------------------------------------
Name | RICHARD ESTRADA
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 214-718-0226
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 251E00000X
-----------------------------------------------------
Taxonomy Name | Home Health Agency
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------