MEDICARE: DDD VENTURES, 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	:	1851722961
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	DDD VENTURES, INC.

Provider Business Mailing Address
First Line	:	581 JERNIGAN RD
Second Line	:
City	:	COPPER CANYON
State	:	TX
Zip	:	75077-8596
Country	:	US
Telephone Number	:	214-543-3607
Fax Number	:

Provider Business Practice Location Address
First Line	:	2609 SAGEBRUSH DR STE 204
Second Line	:
City	:	FLOWER MOUND
State	:	TX
Zip	:	75028-4670
Country	:	US
Telephone Number	:	214-543-3607
Fax Number	:

Authorized Official
Title or Position	:	PRESIDENT
Name	:	MR. KELLY DEAN DAVIS
Credential	:
Telephone Number	:	214-543-3607

Provider Enumeration Date	:	11/29/2013
Last Update Date	:	11/29/2013

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