Provider Demographics
NPI:1598702946
Name:DOVE HOME CARE LLC
Entity Type:Organization
Organization Name:DOVE HOME CARE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:LETTY
Authorized Official - Middle Name:
Authorized Official - Last Name:JOHN
Authorized Official - Suffix:
Authorized Official - Credentials:RN
Authorized Official - Phone:972-864-0473
Mailing Address - Street 1:4105 W SPRING CREEK PKWY
Mailing Address - Street 2:SUITE 612 LB 13
Mailing Address - City:PLANO
Mailing Address - State:TX
Mailing Address - Zip Code:75024-5283
Mailing Address - Country:US
Mailing Address - Phone:972-864-0473
Mailing Address - Fax:972-864-0479
Practice Address - Street 1:4105 W SPRING CREEK PKWY
Practice Address - Street 2:SUITE 612 LB 13
Practice Address - City:PLANO
Practice Address - State:TX
Practice Address - Zip Code:75024-5283
Practice Address - Country:US
Practice Address - Phone:972-864-0473
Practice Address - Fax:972-864-0479
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-01
Last Update Date:2016-06-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX171056801Medicaid
TX001014054OtherPHC
TX453112Medicare ID - Type UnspecifiedMEDICARE PROVIDER NUMBER
TX171056801Medicaid