Provider Demographics
NPI:1245567825
Name:THE SPIRIT NEVER DIES RESIDENCE
Entity Type:Organization
Organization Name:THE SPIRIT NEVER DIES RESIDENCE
Other - Org Name:DALLAS DIRECT TRANSPORTATION
Other - Org Type:Doing Business As
Authorized Official - Title/Position:MANAGING DIRECTOR/PROJECT
Authorized Official - Prefix:
Authorized Official - First Name:ABIOLA
Authorized Official - Middle Name:ISMAEL
Authorized Official - Last Name:BUHARI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:469-363-2760
Mailing Address - Street 1:PO BOX 225112
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75222-5112
Mailing Address - Country:US
Mailing Address - Phone:469-363-2760
Mailing Address - Fax:214-321-4459
Practice Address - Street 1:11117 MYRTICE DR
Practice Address - Street 2:
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75228-2243
Practice Address - Country:US
Practice Address - Phone:469-363-2760
Practice Address - Fax:214-321-4459
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:MEDCOVER LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2009-11-03
Last Update Date:2009-11-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes343900000XTransportation ServicesNon-emergency Medical Transport (VAN)
No253Z00000XAgenciesIn Home Supportive Care
No311ZA0620XNursing & Custodial Care FacilitiesCustodial Care FacilityAdult Care Home
No332BC3200XSuppliersDurable Medical Equipment & Medical SuppliesCustomized Equipment
No332BN1400XSuppliersDurable Medical Equipment & Medical SuppliesNursing Facility Supplies
No347E00000XTransportation ServicesTransportation Broker