Provider Demographics
NPI:1164745451
Name:DALLAS LENDING SOURCE, LLC
Entity Type:Organization
Organization Name:DALLAS LENDING SOURCE, LLC
Other - Org Name:DLS HOME HELATH SERVICES
Other - Org Type:Doing Business As
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MISS
Authorized Official - First Name:MELISSA
Authorized Official - Middle Name:
Authorized Official - Last Name:GIPSON
Authorized Official - Suffix:
Authorized Official - Credentials:BA IN BUSINESS ADMIN
Authorized Official - Phone:214-924-5482
Mailing Address - Street 1:PO BOX 4503
Mailing Address - Street 2:
Mailing Address - City:CEDAR HILL
Mailing Address - State:TX
Mailing Address - Zip Code:75106-4503
Mailing Address - Country:US
Mailing Address - Phone:214-893-3531
Mailing Address - Fax:972-499-2458
Practice Address - Street 1:105 TERRACE DR
Practice Address - Street 2:
Practice Address - City:DESOTO
Practice Address - State:TX
Practice Address - Zip Code:75115-5752
Practice Address - Country:US
Practice Address - Phone:214-893-3531
Practice Address - Fax:972-499-2458
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-03-01
Last Update Date:2022-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes251E00000XAgenciesHome Health
No251J00000XAgenciesNursing CareGroup - Multi-Specialty
No3747P1801XNursing Service Related ProvidersTechnicianPersonal Care AttendantGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX2125353Medicaid