MEDICARE: THE SPIRIT NEVER DIES RESIDENCE

Medicare Provider Information

Scope of Practice

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

#	Taxonomy Code	Taxonomy
1	253Z00000X	In Home Supportive Care Agency
2	311ZA0620X	Adult Care Home Facility
3	347E00000X	Transportation Broker
4	332BN1400X	Nursing Facility Supplies (DME)
5	332BC3200X	Customized Equipment (DME)
6	343900000X	Non-emergency Medical Transport (VAN)

General Provider Information

NPI Number	:	1245567825
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	THE SPIRIT NEVER DIES RESIDENCE

Provider Business Mailing Address
First Line	:	PO BOX 225112
Second Line	:
City	:	DALLAS
State	:	TX
Zip	:	75222-5112
Country	:	US
Telephone Number	:	469-363-2760
Fax Number	:	214-321-4459

Provider Business Practice Location Address
First Line	:	11117 MYRTICE DR
Second Line	:
City	:	DALLAS
State	:	TX
Zip	:	75228-2243
Country	:	US
Telephone Number	:	469-363-2760
Fax Number	:	214-321-4459

Authorized Official
Title or Position	:	MANAGING DIRECTOR/PROJECT
Name	:	ABIOLA ISMAEL BUHARI
Credential	:
Telephone Number	:	469-363-2760

Provider Enumeration Date	:	11/03/2009
Last Update Date	:	11/04/2009

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