MEDICARE: SPIRIT OF AGING IN HOME CARE

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	:	1962745893
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SPIRIT OF AGING IN HOME CARE

Provider Business Mailing Address
First Line	:	1715 E SPRING VALLEY RD
Second Line	:
City	:	RICHARDSON
State	:	TX
Zip	:	75081-5352
Country	:	US
Telephone Number	:	972-671-0292
Fax Number	:

Provider Business Practice Location Address
First Line	:	1715 E SPRING VALLEY RD
Second Line	:
City	:	RICHARDSON
State	:	TX
Zip	:	75081-5352
Country	:	US
Telephone Number	:	972-671-0292
Fax Number	:

Authorized Official
Title or Position	:	PRESIDENT
Name	:	MS. KATHLEEN MAIA
Credential	:	LMSW
Telephone Number	:	972-671-0292

Provider Enumeration Date	:	03/28/2013
Last Update Date	:	03/28/2013

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