Provider Demographics
NPI:1568837326
Name:SENIOR SHEPHERDS OF TEXAS, LLC
Entity Type:Organization
Organization Name:SENIOR SHEPHERDS OF TEXAS, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWER
Authorized Official - Prefix:
Authorized Official - First Name:WYVETTE
Authorized Official - Middle Name:T
Authorized Official - Last Name:ELLIOTT
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:214-683-6433
Mailing Address - Street 1:13166 COUNTY ROAD 183D
Mailing Address - Street 2:
Mailing Address - City:OVERTON
Mailing Address - State:TX
Mailing Address - Zip Code:75684-3102
Mailing Address - Country:US
Mailing Address - Phone:214-683-6433
Mailing Address - Fax:903-984-5154
Practice Address - Street 1:13166 COUNTY ROAD 183D
Practice Address - Street 2:
Practice Address - City:OVERTON
Practice Address - State:TX
Practice Address - Zip Code:75684-3102
Practice Address - Country:US
Practice Address - Phone:214-683-6433
Practice Address - Fax:903-984-5154
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-12-04
Last Update Date:2015-12-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253Z00000XAgenciesIn Home Supportive Care