Provider Demographics
NPI:1003335233
Name:L & B GROUP HOME LLC
Entity Type:Organization
Organization Name:L & B GROUP HOME LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PROGRAM MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:LOVELINE
Authorized Official - Middle Name:I
Authorized Official - Last Name:MUFOR
Authorized Official - Suffix:
Authorized Official - Credentials:RN
Authorized Official - Phone:214-574-6427
Mailing Address - Street 1:605 E PALACE PKWY STE B4
Mailing Address - Street 2:
Mailing Address - City:GRAND PRAIRIE
Mailing Address - State:TX
Mailing Address - Zip Code:75050-2324
Mailing Address - Country:US
Mailing Address - Phone:214-574-6427
Mailing Address - Fax:
Practice Address - Street 1:605 E PALACE PKWY STE
Practice Address - Street 2:B4
Practice Address - City:GRAND PRAIRIE
Practice Address - State:TX
Practice Address - Zip Code:75050
Practice Address - Country:US
Practice Address - Phone:214-574-6427
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-09-19
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253Z00000XAgenciesIn Home Supportive Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX774205OtherTEXAS BOARD NURSING