1871702704 NPI number — PT HOME SERVICES OF DALLAS, INC.

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1871702704 NPI number — PT HOME SERVICES OF DALLAS, INC.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
PT HOME SERVICES OF DALLAS, 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:
Provider Other Organization Name Type Code:
6
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:
1871702704
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
07/18/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
22215 NORTHERN BLVD
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
BAYSIDE
Provider Business Mailing Address State Name:
NY
Provider Business Mailing Address Postal Code:
11361-3603
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
718-468-4747
Provider Business Mailing Address Fax Number:
718-264-5834

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
8200 BROOKRIVER DR
Provider Second Line Business Practice Location Address:
#N503
Provider Business Practice Location Address City Name:
DALLAS
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
75247-4069
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
214-678-0507
Provider Business Practice Location Address Fax Number:
214-678-0766
Provider Enumeration Date:
05/21/2007

Additional Information

Authorized Official

Authorized Official Last Name:
LASKIN
Authorized Official First Name:
LORIGAY
Authorized Official Middle Name:
Authorized Official Title or Position:
CONTRACT MANAGER
Authorized Official Telephone Number:
718-468-4747

Provider Taxonomy Codes

  • Taxonomy code: 251E00000X , with the licence number:  002683 , 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)





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