Provider Demographics
NPI:1003360736
Name:NOSIDRAH ENTERPRISES, LLC
Entity Type:Organization
Organization Name:NOSIDRAH ENTERPRISES, LLC
Other - Org Name:NO PLACE LIKE HOME
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER/ASSISTANT ADMINISTRATOR
Authorized Official - Prefix:MR
Authorized Official - First Name:KEVIN
Authorized Official - Middle Name:MICHAEL
Authorized Official - Last Name:HARDISON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:940-642-5263
Mailing Address - Street 1:4502 LAKE PARK DR
Mailing Address - Street 2:
Mailing Address - City:WICHITA FALLS
Mailing Address - State:TX
Mailing Address - Zip Code:76302-2808
Mailing Address - Country:US
Mailing Address - Phone:940-642-5263
Mailing Address - Fax:
Practice Address - Street 1:4502 LAKE PARK DR
Practice Address - Street 2:
Practice Address - City:WICHITA FALLS
Practice Address - State:TX
Practice Address - Zip Code:76302-2808
Practice Address - Country:US
Practice Address - Phone:940-642-5263
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-08-11
Last Update Date:2016-08-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253Z00000XAgenciesIn Home Supportive Care