MEDICARE: DSM HEALTHCARE VENTURES, 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	261QR0401X	Comprehensive Outpatient Rehabilitation Facility (CORF)

General Provider Information

NPI Number	:	1205159522
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	DSM HEALTHCARE VENTURES, LLC

Provider Business Mailing Address
First Line	:	13619 INWOOD ROAD
Second Line	:	SUITE 325
City	:	FARMERS BRANCH
State	:	TX
Zip	:	75244-4643
Country	:	US
Telephone Number	:	972-239-3633
Fax Number	:	972-239-3636

Provider Business Practice Location Address
First Line	:	13619 INWOOD RD
Second Line	:	SUITE 325
City	:	FARMERS BRANCH
State	:	TX
Zip	:	75244-4643
Country	:	US
Telephone Number	:	972-239-3633
Fax Number	:	972-239-3636

Authorized Official
Title or Position	:	PRESIDENT
Name	:	MR. DAVID SCOTT MITCHELL
Credential	:
Telephone Number	:	214-542-8334

Provider Enumeration Date	:	03/02/2010
Last Update Date	:	03/02/2010

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