Provider Demographics
NPI:1396817086
Name:WANDA D. DENT
Entity Type:Organization
Organization Name:WANDA D. DENT
Other - Org Name:COUNTRY HOME
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:WANDA
Authorized Official - Middle Name:DIANNA
Authorized Official - Last Name:DENT
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:972-539-2557
Mailing Address - Street 1:901 CROSS TIMBERS DR.
Mailing Address - Street 2:
Mailing Address - City:DOUBLE OAK
Mailing Address - State:TX
Mailing Address - Zip Code:75077
Mailing Address - Country:US
Mailing Address - Phone:972-539-2557
Mailing Address - Fax:972-539-8499
Practice Address - Street 1:901 CROSS TIMBERS DR
Practice Address - Street 2:
Practice Address - City:DOUBLE OAK
Practice Address - State:TX
Practice Address - Zip Code:75077-8402
Practice Address - Country:US
Practice Address - Phone:972-539-2557
Practice Address - Fax:972-539-8499
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-15
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX315P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes315P00000XNursing & Custodial Care FacilitiesIntermediate Care Facility, Intellectual Disabilities