MEDICARE: GREATER IMPRESSIONS RESIDENTIAL CARE, LLC

Medicare Provider Information

Scope of Practice

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

#	Taxonomy Code	Taxonomy
1	313M00000X	Nursing Facility/Intermediate Care Facility
2	311ZA0620X	Adult Care Home Facility
3	311Z00000X	Custodial Care Facility
4	320600000X	Intellectual and/or Developmental Disabilities Residential Treatment Facility
5	385H00000X	Respite Care
6	320900000X	Intellectual and/or Developmental Disabilities Community Based Residential Treatment Facility

General Provider Information

NPI Number	:	1215537717
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	GREATER IMPRESSIONS RESIDENTIAL CARE, LLC

Provider Business Mailing Address
First Line	:	5787 S HAMPTON RD STE 203
Second Line	:
City	:	DALLAS
State	:	TX
Zip	:	75232-2255
Country	:	US
Telephone Number	:	469-478-0573
Fax Number	:

Provider Business Practice Location Address
First Line	:	5787 S HAMPTON RD STE 203
Second Line	:
City	:	DALLAS
State	:	TX
Zip	:	75232-2255
Country	:	US
Telephone Number	:	469-478-0573
Fax Number	:

Authorized Official
Title or Position	:	PROGRAM DIRECTOR
Name	:	LACINDER ROSEANN KING-FULTON
Credential	:	LMSW
Telephone Number	:	469-478-0573

Provider Enumeration Date	:	10/26/2020
Last Update Date	:	03/23/2026

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