Provider Demographics
NPI:1437113867
Name:DIGNIFIED CHRISTIAN HEALTHCARE SERVICES,INC
Entity Type:Organization
Organization Name:DIGNIFIED CHRISTIAN HEALTHCARE SERVICES,INC
Other - Org Name:DBA: CLASSIC HOME HEALTH CARE SERVICES
Other - Org Type:Doing Business As
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:FLORENCE
Authorized Official - Middle Name:
Authorized Official - Last Name:ENOUDO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:972-840-1650
Mailing Address - Street 1:12959 JUPITER ROAD
Mailing Address - Street 2:SUITE 249
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75238
Mailing Address - Country:US
Mailing Address - Phone:214-393-7421
Mailing Address - Fax:214-393-7424
Practice Address - Street 1:12959 JUPITER ROAD
Practice Address - Street 2:SUITE 249
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75238
Practice Address - Country:US
Practice Address - Phone:214-393-7421
Practice Address - Fax:214-393-7424
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-04-13
Last Update Date:2013-08-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX009140251E00000X
251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX679288Medicare ID - Type UnspecifiedMEDICARE PROVIDER NUMBER