1164745451 NPI number — DALLAS LENDING SOURCE, LLC

Table of content: (NPI 1164745451)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1164745451 NPI number — DALLAS LENDING SOURCE, LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
DALLAS LENDING SOURCE, LLC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
DLS HOME HELATH SERVICES
Provider Other Organization Name Type Code:
3
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1164745451
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
03/17/2022
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 4503
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
CEDAR HILL
Provider Business Mailing Address State Name:
TX
Provider Business Mailing Address Postal Code:
75106-4503
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
214-893-3531
Provider Business Mailing Address Fax Number:
972-499-2458

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
105 TERRACE DR
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
DESOTO
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
75115-5752
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
214-893-3531
Provider Business Practice Location Address Fax Number:
972-499-2458
Provider Enumeration Date:
03/01/2010

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
GIPSON
Authorized Official First Name:
MELISSA
Authorized Official Middle Name:
Authorized Official Title or Position:
ADMINISTRATOR
Authorized Official Telephone Number:
214-924-5482

Provider Taxonomy Codes

  • Taxonomy code: 251E00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 251J00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 3747P1801X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 2125353 , issued by the state of ( TX ) . This identifiers is of the category "MEDICAID".