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NPI Code Detail

MEDICARE: DIGNIFIED HOME CARE FOR SENIORS LLC

MEDICARE: DIGNIFIED HOME CARE FOR SENIORS 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
1253Z00000XIn Home Supportive Care Agency

General Provider Information

NPI Number : 1174935936
Entity Type Code : Organization
Provider Name (Legal Business Name) : DIGNIFIED HOME CARE FOR SENIORS LLC
Provider Business Mailing Address
First Line : 5724 COMANCHE PEAK DR
Second Line :
City : FORT WORTH
State : TX
Zip : 76179-7103
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 5724 COMANCHE PEAK DR
Second Line :
City : FORT WORTH
State : TX
Zip : 76179-7103
Country : US
Telephone Number : 817-891-0645
Fax Number :
Authorized Official
Title or Position : ADMINISTRATOR/ PRESIDENT
Name : JESSE MITAMBO
Credential :
Telephone Number : 817-891-0645
Provider Enumeration Date : 05/28/2014
Last Update Date : 05/28/2014

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Directions to “DIGNIFIED HOME CARE FOR SENIORS LLC ” Practice Location

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