MEDICARE: HEALTHCOR INTEGRATION LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	310400000X	Assisted Living Facility

General Provider Information

NPI Number	:	1114573177
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	HEALTHCOR INTEGRATION LLC

Provider Business Mailing Address
First Line	:	10935 ESTATE LN # 213
Second Line	:
City	:	DALLAS
State	:	TX
Zip	:	75238-2316
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	402 DUNCAN PERRY RD
Second Line	:
City	:	GRAND PRAIRIE
State	:	TX
Zip	:	75050-2907
Country	:	US
Telephone Number	:	214-843-5403
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	AQUA UMOREN
Credential	:
Telephone Number	:	214-336-3683

Provider Enumeration Date	:	08/15/2019
Last Update Date	:	05/06/2020

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Directions to “HEALTHCOR INTEGRATION LLC ” Practice Location

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