1780686998 NPI number — DALLAS LIFE SUPPORT SYSTEMS, INC

Table of content: (NPI 1780686998)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1780686998 NPI number — DALLAS LIFE SUPPORT SYSTEMS, INC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
DALLAS LIFE SUPPORT SYSTEMS, INC
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:
LIFE SUPPORT SYSTEMS
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:
1780686998
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
04/16/2024
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
7440 WHITEHALL ST
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
RICHLAND HILLS
Provider Business Mailing Address State Name:
TX
Provider Business Mailing Address Postal Code:
76118-6426
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
817-284-7788
Provider Business Mailing Address Fax Number:
817-284-7780

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
7440 WHITEHALL ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
RICHLAND HILLS
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
76118-6426
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
817-284-7788
Provider Business Practice Location Address Fax Number:
817-284-7780
Provider Enumeration Date:
06/01/2005

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
GARBER
Authorized Official First Name:
SCOTT
Authorized Official Middle Name:
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
817-284-7788

Provider Taxonomy Codes

  • Taxonomy code: 332BP3500X , with the licence number:  0030830 , registered in the state of TX ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 332BX2000X , with the licence number: 0030830 , registered in the state of TX ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 079335801 , issued by the state of ( TX ) . This identifiers is of the category "MEDICAID".
  • Identifier: 087426501 , issued by the state of ( TX ) . This identifiers is of the category "MEDICAID".
  • Identifier: 016174701 , issued by the state of ( TX ) . This identifiers is of the category "MEDICAID".