1689688517 NPI number — TEXAS LIFELINE CORPORATION OF LIVE OAK CO.

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 1689688517 NPI number — TEXAS LIFELINE CORPORATION OF LIVE OAK CO.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
TEXAS LIFELINE CORPORATION OF LIVE OAK CO.
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:
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:
1689688517
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/22/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 571909
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
DALLAS
Provider Business Mailing Address State Name:
TX
Provider Business Mailing Address Postal Code:
75357-1909
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
214-327-8222
Provider Business Mailing Address Fax Number:
214-388-2093

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
5409 N JIM MILLER RD
Provider Second Line Business Practice Location Address:
SUITE 203A
Provider Business Practice Location Address City Name:
DALLAS
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
75227-1542
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
214-327-8222
Provider Business Practice Location Address Fax Number:
214-388-2093
Provider Enumeration Date:
07/28/2006

Additional Information

Authorized Official

Authorized Official Last Name:
QUIGLEY
Authorized Official First Name:
DARRYL
Authorized Official Middle Name:
Authorized Official Title or Position:
CHIEF OPERATING OFFICER
Authorized Official Telephone Number:
214-327-8222

Provider Taxonomy Codes

  • Taxonomy code: 341600000X , with the licence number:  300273 , 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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