MEDICARE: STOVALL SENIOR SOLUTIONS INC

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	253Z00000X	In Home Supportive Care Agency

General Provider Information

NPI Number	:	1285972539
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	STOVALL SENIOR SOLUTIONS INC

Provider Business Mailing Address
First Line	:	2947 NADAR
Second Line	:
City	:	GRAND PRAIRIE
State	:	TX
Zip	:	75054-6729
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	2947 NADAR
Second Line	:
City	:	GRAND PRAIRIE
State	:	TX
Zip	:	75054-6729
Country	:	US
Telephone Number	:	713-320-9549
Fax Number	:

Authorized Official
Title or Position	:	PRESIDENT
Name	:	BRIANNA STOVALL
Credential	:
Telephone Number	:	713-320-9549

Provider Enumeration Date	:	01/22/2013
Last Update Date	:	01/22/2013

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