Provider Demographics
NPI:1578034922
Name:DIGNIFIED HOMECARE FOR SENIORS LLC
Entity Type:Organization
Organization Name:DIGNIFIED HOMECARE FOR SENIORS LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MR
Authorized Official - First Name:JESSE
Authorized Official - Middle Name:
Authorized Official - Last Name:MITAMBO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:817-891-0645
Mailing Address - Street 1:8701 BEDFORD EULESS RD STE 310
Mailing Address - Street 2:
Mailing Address - City:HURST
Mailing Address - State:TX
Mailing Address - Zip Code:76053-3804
Mailing Address - Country:US
Mailing Address - Phone:817-891-0645
Mailing Address - Fax:
Practice Address - Street 1:8701 BEDFORD EULESS RD STE 310
Practice Address - Street 2:
Practice Address - City:HURST
Practice Address - State:TX
Practice Address - Zip Code:76053-3804
Practice Address - Country:US
Practice Address - Phone:817-891-0645
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-12-11
Last Update Date:2018-12-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253Z00000XAgenciesIn Home Supportive Care