Provider Demographics
NPI:1275252652
Name:NIMROD NATION ENTERPRISE LLC
Entity Type:Organization
Organization Name:NIMROD NATION ENTERPRISE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:RASBY
Authorized Official - Middle Name:G
Authorized Official - Last Name:MASON
Authorized Official - Suffix:III
Authorized Official - Credentials:
Authorized Official - Phone:318-230-8410
Mailing Address - Street 1:1700 W POLO RD STE 128
Mailing Address - Street 2:
Mailing Address - City:GRAND PRAIRIE
Mailing Address - State:TX
Mailing Address - Zip Code:75052-1821
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:318-626-7179
Practice Address - Street 1:1700 W POLO RD STE 128
Practice Address - Street 2:
Practice Address - City:GRAND PRAIRIE
Practice Address - State:TX
Practice Address - Zip Code:75052-1821
Practice Address - Country:US
Practice Address - Phone:318-230-8414
Practice Address - Fax:318-626-7179
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-08-26
Last Update Date:2022-08-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA0600XAmbulatory Health Care FacilitiesClinic/CenterAdult Day Care
No174200000XOther Service ProvidersMeals
No177F00000XOther Service ProvidersLodging
No251300000XAgenciesLocal Education Agency (LEA)
No251B00000XAgenciesCase Management
No251E00000XAgenciesHome Health
No251S00000XAgenciesCommunity/Behavioral Health
No251T00000XAgenciesProgram of All-Inclusive Care for the Elderly (PACE) Provider Organization
No252Y00000XAgenciesEarly Intervention Provider Agency
No253Z00000XAgenciesIn Home Supportive Care
No261QM0855XAmbulatory Health Care FacilitiesClinic/CenterAdolescent and Children Mental Health
No261QV0200XAmbulatory Health Care FacilitiesClinic/CenterVA
No343900000XTransportation ServicesNon-emergency Medical Transport (VAN)