Provider Demographics
NPI:1578943312
Name:SILVERTRAIL OMPASSION CAE.LLC
Entity Type:Organization
Organization Name:SILVERTRAIL OMPASSION CAE.LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MS
Authorized Official - First Name:GRADA
Authorized Official - Middle Name:
Authorized Official - Last Name:BERRY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:682-217-5822
Mailing Address - Street 1:PO BOX 540574
Mailing Address - Street 2:
Mailing Address - City:GRAND PRAIRIE
Mailing Address - State:TX
Mailing Address - Zip Code:75054-0574
Mailing Address - Country:US
Mailing Address - Phone:817-633-0383
Mailing Address - Fax:
Practice Address - Street 1:2520 HEATHER BROOK LN APT 804
Practice Address - Street 2:
Practice Address - City:ARLINGTON
Practice Address - State:TX
Practice Address - Zip Code:76006-5177
Practice Address - Country:US
Practice Address - Phone:817-633-0383
Practice Address - Fax:817-633-0084
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-06-07
Last Update Date:2015-06-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX016187251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health