MEDICARE: DAVID AND LY, 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	251E00000X	Home Health Agency

General Provider Information

NPI Number	:	1265960363
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	DAVID AND LY, LLC.

Provider Business Mailing Address
First Line	:	8230 TWIN TREE LN
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77071-2918
Country	:	US
Telephone Number	:	832-867-3571
Fax Number	:

Provider Business Practice Location Address
First Line	:	4916 W 34TH ST # A
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77092-6606
Country	:	US
Telephone Number	:	832-867-3571
Fax Number	:

Authorized Official
Title or Position	:	OWNER/PRESIDENT
Name	:	DAVID LEE LATTIN
Credential	:
Telephone Number	:	832-867-3571

Provider Enumeration Date	:	06/01/2017
Last Update Date	:	06/01/2017

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