Provider Demographics
NPI:1073814927
Name:DSM HEALTHCARE VENTURES, LLC
Entity Type:Organization
Organization Name:DSM HEALTHCARE VENTURES, LLC
Other - Org Name:TRITRAX REHABILITATION
Other - Org Type:Doing Business As
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MS
Authorized Official - First Name:LAUREN
Authorized Official - Middle Name:
Authorized Official - Last Name:VIELMA COBLER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:817-652-2924
Mailing Address - Street 1:1901 N HWY 360 STE 410
Mailing Address - Street 2:
Mailing Address - City:GRAND PRAIRIE
Mailing Address - State:TX
Mailing Address - Zip Code:75050-1431
Mailing Address - Country:US
Mailing Address - Phone:972-239-3633
Mailing Address - Fax:972-239-3636
Practice Address - Street 1:1901 N HWY 360 STE 410
Practice Address - Street 2:
Practice Address - City:GRAND PRAIRIE
Practice Address - State:TX
Practice Address - Zip Code:75050-1431
Practice Address - Country:US
Practice Address - Phone:817-652-2924
Practice Address - Fax:855-239-3636
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:DSM HEALTHCARE VENTURES, LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2010-11-09
Last Update Date:2019-07-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX168342703Medicaid
TX018505OtherTEXAS HEALTH AND HUMAN SERVICES COMMISSION