Provider Demographics
NPI:1518424555
Name:INTERTWINED SENIOR CARE, LLC
Entity Type:Organization
Organization Name:INTERTWINED SENIOR CARE, LLC
Other - Org Name:EXTENDED FAMILY HOME CARE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:KELLEY
Authorized Official - Middle Name:
Authorized Official - Last Name:MONROE
Authorized Official - Suffix:
Authorized Official - Credentials:RN
Authorized Official - Phone:817-344-0004
Mailing Address - Street 1:5512 LAVACA RD
Mailing Address - Street 2:
Mailing Address - City:GRAND PRAIRIE
Mailing Address - State:TX
Mailing Address - Zip Code:75052-8566
Mailing Address - Country:US
Mailing Address - Phone:817-344-0004
Mailing Address - Fax:
Practice Address - Street 1:5512 LAVACA RD
Practice Address - Street 2:
Practice Address - City:GRAND PRAIRIE
Practice Address - State:TX
Practice Address - Zip Code:75052-8566
Practice Address - Country:US
Practice Address - Phone:817-344-0004
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:INTERTWINED SENIOR CARE, LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2019-02-26
Last Update Date:2019-11-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health