MEDICARE: TRUST IN GOD HOME HEALTHCARE 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	3747P1801X	Personal Care Attendant

General Provider Information

NPI Number	:	1841809639
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	TRUST IN GOD HOME HEALTHCARE LLC

Provider Business Mailing Address
First Line	:	1531 DUNCANVILLE RD APT 1002
Second Line	:
City	:	DALLAS
State	:	TX
Zip	:	75211-6578
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	6405 GENTLE RIVER DR
Second Line	:
City	:	DALLAS
State	:	TX
Zip	:	75241-5923
Country	:	US
Telephone Number	:	469-449-3802
Fax Number	:

Authorized Official
Title or Position	:	ADMINISTRATOR/OWNER
Name	:	PATRICE HOLLEMAN
Credential	:
Telephone Number	:	469-449-3802

Provider Enumeration Date	:	07/28/2020
Last Update Date	:	08/07/2020

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Directions to “TRUST IN GOD HOME HEALTHCARE LLC ” Practice Location

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